- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.00 / $1,300.00 / $3,500.00
| Facility | | $297.00 | $1,300.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,908.30 / $3,728.94 / $5,325.91
| Facility | | $1,908.30 | $3,728.94 | $5,325.91 |
- 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
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |