- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.17 / $1,850.00 / $3,945.00
| Facility | | $676.17 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,638.75 / $3,012.34 / $7,476.46
| Facility | | $1,638.75 | $3,012.34 | $7,476.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $498.52
| Facility | | $40.00 | $40.00 | $498.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.00 / $2,802.00 / $7,984.00
| Facility | | $826.00 | $2,802.00 | $7,984.00 |