- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.00 / $1,172.00 / $3,500.00
| Facility | | $338.00 | $1,172.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,146.60 / $3,816.03 / $5,331.36
| Facility | | $2,146.60 | $3,816.03 | $5,331.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $199.65
| Facility | | $40.00 | $40.00 | $199.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $425.00 / $425.00
| Facility | | $425.00 | $425.00 | $425.00 |
- 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 |