- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.73 / $1,300.00 / $3,500.00
| Facility | | $419.73 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,043.69 / $4,548.21 / $6,578.64
| Facility | | $2,043.69 | $4,548.21 | $6,578.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $330.83
| Facility | | $40.00 | $40.00 | $330.83 |
- 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 |