- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.88 / $1,850.00 / $3,945.00
| Facility | | $617.88 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,642.19 / $5,096.85 / $7,123.70
| Facility | | $2,642.19 | $5,096.85 | $7,123.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $461.91
| Facility | | $40.00 | $40.00 | $461.91 |
- 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
- $1,039.00 / $3,602.00 / $11,347.00
| Facility | | $1,039.00 | $3,602.00 | $11,347.00 |