- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.00 / $1,300.00 / $3,500.00
| Facility | | $497.00 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,658.46 / $3,374.38 / $6,938.11
| Facility | | $1,658.46 | $3,374.38 | $6,938.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $680.20
| Facility | | $40.00 | $40.00 | $680.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,433.00 / $4,123.00
| Facility | | $470.00 | $1,433.00 | $4,123.00 |