- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.67 / $1,850.00 / $4,050.00
| Facility | | $742.67 | $1,850.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,695.45 / $3,140.45 / $4,797.76
| Facility | | $1,695.45 | $3,140.45 | $4,797.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $458.11
| Facility | | $40.00 | $40.00 | $458.11 |
- 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 |