- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.75 / $1,850.00 / $3,945.00
| Facility | | $568.75 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,460.05 / $6,587.54 / $13,982.44
| Facility | | $3,460.05 | $6,587.54 | $13,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $418.48
| Facility | | $40.00 | $40.00 | $418.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,200.00 / $1,200.00
| Facility | | $1,200.00 | $1,200.00 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |