- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $1,850.00 / $3,884.00
| Facility | | $612.00 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,607.97 / $3,312.82 / $5,168.50
| Facility | | $1,607.97 | $3,312.82 | $5,168.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $458.09
| Facility | | $40.00 | $40.00 | $458.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,200.00 / $1,200.00
| Facility | | $1,200.00 | $1,200.00 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |