- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,744.00 / $3,884.00
| Facility | | $580.00 | $1,744.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,383.37 / $6,449.50 / $13,753.10
| Facility | | $3,383.37 | $6,449.50 | $13,753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $398.64
| Facility | | $40.00 | $40.00 | $398.64 |
- 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 |