- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.00 / $1,280.60 / $3,500.00
| Facility | | $497.00 | $1,280.60 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.51 / $3,116.18 / $11,442.56
| Facility | | $1,454.51 | $3,116.18 | $11,442.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $638.83
| Facility | | $40.00 | $40.00 | $638.83 |
- 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
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |