- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $1,566.02 / $3,728.00
| Facility | | $646.00 | $1,566.02 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,667.81 / $3,697.35 / $11,078.52
| Facility | | $1,667.81 | $3,697.35 | $11,078.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,094.92
| Facility | | $40.00 | $40.00 | $1,094.92 |
- 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 |