- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.00 / $2,090.00 / $4,050.00
| Facility | | $562.00 | $2,090.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,383.37 / $6,419.81 / $13,151.92
| Facility | | $3,383.37 | $6,419.81 | $13,151.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $376.68
| Facility | | $40.00 | $40.00 | $376.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- 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 |