- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,893.00 / $4,050.00
| Facility | | $762.00 | $1,893.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,532.83 / $3,032.71 / $6,697.08
| Facility | | $1,532.83 | $3,032.71 | $6,697.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,121.14
| Facility | | $40.00 | $40.00 | $1,121.14 |
- 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
- $746.00 / $2,420.00 / $7,085.00
| Facility | | $746.00 | $2,420.00 | $7,085.00 |