- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.00 / $1,300.00 / $2,000.00
| Facility | | $641.00 | $1,300.00 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.36 / $195.36 / $195.36
| Facility | | $195.36 | $195.36 | $195.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.00 / $1,150.00 / $3,150.00
| Facility | | $925.00 | $1,150.00 | $3,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.00 / $1,047.00 / $2,472.00
| Facility | | $450.00 | $1,047.00 | $2,472.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.00 / $807.00 / $1,612.00
| Facility | | $450.00 | $807.00 | $1,612.00 |