- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.00 / $2,397.00 / $4,509.00
| Facility | | $562.00 | $2,397.00 | $4,509.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.55 / $2,745.65 / $4,442.46
| Facility | | $1,336.55 | $2,745.65 | $4,442.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $376.33
| Facility | | $40.00 | $40.00 | $376.33 |
- 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 |