- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.00 / $1,273.00 / $3,500.00
| Facility | | $483.00 | $1,273.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,601.67 / $5,124.22 / $7,389.47
| Facility | | $2,601.67 | $5,124.22 | $7,389.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $694.68
| Facility | | $40.00 | $40.00 | $694.68 |
- 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
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |