- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.00 / $1,273.00 / $3,500.00
| Facility | | $297.00 | $1,273.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,191.36 / $3,832.80 / $6,018.56
| Facility | | $2,191.36 | $3,832.80 | $6,018.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $150.94
| Facility | | $40.00 | $40.00 | $150.94 |
- 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 |