- 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
- $1,336.55 / $2,719.14 / $4,076.46
| Facility | | $1,336.55 | $2,719.14 | $4,076.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $589.55
| Facility | | $40.00 | $40.00 | $589.55 |
- 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 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |