- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.00 / $1,300.00 / $3,685.00
| Facility | | $497.00 | $1,300.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.06 / $4,595.72 / $6,455.40
| Facility | | $1,550.06 | $4,595.72 | $6,455.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.33 / $427.33 / $427.33
| Facility | | $427.33 | $427.33 | $427.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $6,034.00 / $13,506.00
| Facility | | $1,200.00 | $6,034.00 | $13,506.00 |