- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.00 / $1,850.00 / $3,945.00
| Facility | | $519.00 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,340.52 / $4,548.21 / $6,578.64
| Facility | | $2,340.52 | $4,548.21 | $6,578.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $317.14
| Facility | | $40.00 | $40.00 | $317.14 |
- 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
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |