- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.90 / $2,758.00 / $5,432.00
| Facility | | $770.90 | $2,758.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,534.06 / $4,245.51 / $6,455.18
| Facility | | $2,534.06 | $4,245.51 | $6,455.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $458.72
| Facility | | $40.00 | $40.00 | $458.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $1,650.00 / $1,650.00
| Facility | | $1,650.00 | $1,650.00 | $1,650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |