- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.00 / $1,236.00 / $3,500.00
| Facility | | $497.00 | $1,236.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.77 / $2,748.95 / $6,018.56
| Facility | | $583.77 | $2,748.95 | $6,018.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $540.29
| Facility | | $40.00 | $40.00 | $540.29 |
- 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
- $470.00 / $1,433.00 / $4,123.00
| Facility | | $470.00 | $1,433.00 | $4,123.00 |