- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.00 / $1,850.00 / $3,945.00
| Facility | | $598.00 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,601.67 / $4,715.26 / $6,578.64
| Facility | | $2,601.67 | $4,715.26 | $6,578.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $430.21
| Facility | | $40.00 | $40.00 | $430.21 |
- 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 |