- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.95 / $1,850.00 / $3,945.00
| Facility | | $608.95 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,254.68 / $2,655.59 / $4,442.46
| Facility | | $1,254.68 | $2,655.59 | $4,442.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $451.84
| Facility | | $40.00 | $40.00 | $451.84 |
- 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
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |