- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,850.00 / $3,945.00
| Facility | | $762.00 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,416.25 / $3,063.05 / $5,754.41
| Facility | | $1,416.25 | $3,063.05 | $5,754.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $697.07
| Facility | | $40.00 | $40.00 | $697.07 |
- 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
- $1,027.00 / $3,501.00 / $9,520.00
| Facility | | $1,027.00 | $3,501.00 | $9,520.00 |