- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.00 / $2,166.00 / $5,547.00
| Facility | | $1,054.00 | $2,166.00 | $5,547.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,132.00 / $1,488.00 / $1,724.00
| Facility | | $1,132.00 | $1,488.00 | $1,724.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.00 / $1,017.00 / $1,295.00
| Facility | | $886.00 | $1,017.00 | $1,295.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $4,599.00 / $82,033.00
| Facility | | $1,456.00 | $4,599.00 | $82,033.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.00 / $1,200.00 / $2,560.00
| Facility | | $910.00 | $1,200.00 | $2,560.00 |