- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.00 / $3,734.00 / $5,000.00
| Facility | | $2,630.00 | $3,734.00 | $5,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.40 / $2,714.00 / $4,995.50
| Facility | | $1,866.40 | $2,714.00 | $4,995.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $2,328.00 / $6,755.00
| Facility | | $490.00 | $2,328.00 | $6,755.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.00 / $415.00 / $523.00
| Facility | | $380.00 | $415.00 | $523.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.00 / $3,346.00 / $5,255.00
| Facility | | $1,166.00 | $3,346.00 | $5,255.00 |