- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.61 / $1,850.00 / $3,945.00
| Facility | | $524.61 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.06 / $2,835.71 / $4,442.46
| Facility | | $1,343.06 | $2,835.71 | $4,442.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $442.91
| Facility | | $40.00 | $40.00 | $442.91 |
- 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
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |