- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.32 / $1,850.00 / $3,945.00
| Facility | | $755.32 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,004.66 / $9,145.96 / $13,354.75
| Facility | | $4,004.66 | $9,145.96 | $13,354.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $564.24
| Facility | | $40.00 | $40.00 | $564.24 |
- 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
- $826.00 / $2,423.00 / $7,611.00
| Facility | | $826.00 | $2,423.00 | $7,611.00 |