- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,397.00 / $4,509.00
| Facility | | $756.00 | $2,397.00 | $4,509.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,601.67 / $5,047.04 / $7,123.70
| Facility | | $2,601.67 | $5,047.04 | $7,123.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $582.58
| Facility | | $40.00 | $40.00 | $582.58 |
- 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
- $1,027.00 / $3,501.00 / $9,520.00
| Facility | | $1,027.00 | $3,501.00 | $9,520.00 |