- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.00 / $1,300.00 / $3,500.00
| Facility | | $483.00 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $4,838.85 / $6,815.16
| Facility | | $2,712.54 | $4,838.85 | $6,815.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $641.09
| Facility | | $40.00 | $40.00 | $641.09 |
- 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
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |