- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.75 / $1,520.00 / $3,685.00
| Facility | | $455.75 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,297.79 / $4,340.72 / $6,168.35
| Facility | | $2,297.79 | $4,340.72 | $6,168.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $347.67
| Facility | | $40.00 | $40.00 | $347.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- 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 |