- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,850.00 / $3,945.00
| Facility | | $762.00 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,581.66 / $8,397.57 / $13,151.92
| Facility | | $3,581.66 | $8,397.57 | $13,151.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $641.97
| Facility | | $40.00 | $40.00 | $641.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.00 / $2,802.00 / $7,984.00
| Facility | | $826.00 | $2,802.00 | $7,984.00 |