- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,893.00 / $3,945.00
| Facility | | $762.00 | $1,893.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,514.84 / $4,650.64 / $7,524.75
| Facility | | $2,514.84 | $4,650.64 | $7,524.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,196.68
| Facility | | $40.00 | $40.00 | $1,196.68 |
- 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 |