- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.00 / $1,142.00 / $3,500.00
| Facility | | $497.00 | $1,142.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.77 / $1,361.08 / $2,979.96
| Facility | | $583.77 | $1,361.08 | $2,979.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $410.89
| Facility | | $40.00 | $40.00 | $410.89 |
- 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
- $194.00 / $543.00 / $1,560.00
| Facility | | $194.00 | $543.00 | $1,560.00 |