- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,397.00 / $4,050.00
| Facility | | $756.00 | $2,397.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,361.08 / $2,924.80 / $5,754.41
| Facility | | $1,361.08 | $2,924.80 | $5,754.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $684.82
| Facility | | $40.00 | $40.00 | $684.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- 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 |