- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.71 / $2,500.00 / $4,050.00
| Facility | | $767.71 | $2,500.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.70 / $901.77 / $1,358.46
| Facility | | $437.70 | $901.77 | $1,358.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $534.10
| Facility | | $40.00 | $40.00 | $534.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $425.00 / $425.00
| Facility | | $425.00 | $425.00 | $425.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.00 / $678.00 / $1,817.00
| Facility | | $211.00 | $678.00 | $1,817.00 |