- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.00 / $1,300.00 / $3,500.00
| Facility | | $338.00 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.92 / $2,685.94 / $3,923.70
| Facility | | $1,187.92 | $2,685.94 | $3,923.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $103.85 / $103.85
| Facility | | $40.00 | $103.85 | $103.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.12 / $650.00 / $720.00
| Facility | | $134.12 | $650.00 | $720.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,433.00 / $4,010.00
| Facility | | $470.00 | $1,433.00 | $4,010.00 |