- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,850.00 / $4,050.00
| Facility | | $580.00 | $1,850.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,739.66 / $6,018.56 / $10,692.30
| Facility | | $2,739.66 | $6,018.56 | $10,692.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $384.20
| Facility | | $40.00 | $40.00 | $384.20 |
- 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 |