- 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
- $2,906.55 / $4,873.21 / $7,458.32
| Facility | | $2,906.55 | $4,873.21 | $7,458.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.00 / $451.00 / $451.00
| Facility | | $451.00 | $451.00 | $451.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.00 / $3,820.00 / $8,993.50
| Facility | | $1,039.00 | $3,820.00 | $8,993.50 |