- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,850.00 / $3,945.00
| Facility | | $580.00 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,860.36 / $5,345.97 / $8,874.29
| Facility | | $2,860.36 | $5,345.97 | $8,874.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $375.09
| Facility | | $40.00 | $40.00 | $375.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.00 / $1,802.00 / $1,802.00
| Facility | | $1,802.00 | $1,802.00 | $1,802.00 |
- 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 |