- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.92 / $1,850.00 / $3,945.00
| Facility | | $743.92 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $5,271.23 / $7,712.17
| Facility | | $2,712.54 | $5,271.23 | $7,712.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $606.61
| Facility | | $40.00 | $40.00 | $606.61 |
- 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
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |