- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.00 / $1,520.00 / $3,685.00
| Facility | | $508.00 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.61 / $2,872.07 / $5,754.41
| Facility | | $1,307.61 | $2,872.07 | $5,754.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $354.32
| Facility | | $40.00 | $40.00 | $354.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |