- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.00 / $2,418.00 / $5,150.00
| Facility | | $841.00 | $2,418.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.42 / $3,110.96 / $4,854.39
| Facility | | $1,074.42 | $3,110.96 | $4,854.39 |
- 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
- $965.00 / $965.00 / $965.00
| Facility | | $965.00 | $965.00 | $965.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,752.00 / $5,001.96
| Facility | | $500.00 | $1,752.00 | $5,001.96 |