- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,850.00 / $3,884.00
| Facility | | $580.00 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $4,762.07 / $6,757.79
| Facility | | $2,712.54 | $4,762.07 | $6,757.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $377.72
| Facility | | $40.00 | $40.00 | $377.72 |
- 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 |