- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.88 / $2,418.00 / $5,150.00
| Facility | | $695.88 | $2,418.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $5,175.18 / $7,440.81
| Facility | | $2,712.54 | $5,175.18 | $7,440.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $510.73
| Facility | | $40.00 | $40.00 | $510.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,400.00 / $1,400.00
| Facility | | $1,400.00 | $1,400.00 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |