- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.73 / $1,850.00 / $3,945.00
| Facility | | $742.73 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,534.06 / $4,264.56 / $6,578.64
| Facility | | $2,534.06 | $4,264.56 | $6,578.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $614.10
| Facility | | $40.00 | $40.00 | $614.10 |
- 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 |