- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.00 / $1,300.00 / $3,500.00
| Facility | | $483.00 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,419.07 / $4,629.75 / $6,849.11
| Facility | | $2,419.07 | $4,629.75 | $6,849.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $554.52 / $1,883.73
| Facility | | $40.00 | $554.52 | $1,883.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $535.00 / $2,711.98
| Facility | | $488.00 | $535.00 | $2,711.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $8,488.00
| Facility | | $882.00 | $3,238.00 | $8,488.00 |