- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.00 / $1,300.00 / $3,500.00
| Facility | | $497.00 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.06 / $2,728.26 / $4,087.58
| Facility | | $1,343.06 | $2,728.26 | $4,087.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.48 / $2,117.84 / $2,117.84
| Facility | | $431.48 | $2,117.84 | $2,117.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |