- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.57 / $1,372.00 / $3,685.00
| Facility | | $465.57 | $1,372.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,393.62 / $3,059.08 / $5,523.68
| Facility | | $1,393.62 | $3,059.08 | $5,523.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $361.96
| Facility | | $40.00 | $40.00 | $361.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |