- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,520.00 / $3,728.00
| Facility | | $580.00 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,951.50 / $3,480.26 / $4,743.79
| Facility | | $1,951.50 | $3,480.26 | $4,743.79 |
- 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
- $600.00 / $600.00 / $600.00
| Facility | | $600.00 | $600.00 | $600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.00 / $2,653.00 / $6,661.00
| Facility | | $826.00 | $2,653.00 | $6,661.00 |