- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,458.00 / $10,126.00 / $10,126.00
| Facility | | $6,458.00 | $10,126.00 | $10,126.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $1,400.00 / $27,134.00
| Facility | | $750.00 | $1,400.00 | $27,134.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.00 / $475.00 / $475.00
| Facility | | $475.00 | $475.00 | $475.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $2,457.58 / $10,126.00
| Facility | | $455.00 | $2,457.58 | $10,126.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,280.00 / $3,280.00 / $3,280.00
| Facility | | $3,280.00 | $3,280.00 | $3,280.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,450.00 / $2,500.00
| Facility | | $500.00 | $1,450.00 | $2,500.00 |