- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.83 / $1,850.00 / $3,884.00
| Facility | | $451.83 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,146.60 / $3,816.03 / $5,331.36
| Facility | | $2,146.60 | $3,816.03 | $5,331.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $209.56
| Facility | | $40.00 | $40.00 | $209.56 |
- 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
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |