- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.10 / $2,418.00 / $5,150.00
| Facility | | $581.10 | $2,418.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,489.37 / $4,239.58 / $6,022.01
| Facility | | $2,489.37 | $4,239.58 | $6,022.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $358.66
| Facility | | $40.00 | $40.00 | $358.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,400.00 / $1,400.00
| Facility | | $1,400.00 | $1,400.00 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |