- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $2,125.00 / $4,036.95
| Facility | | $762.00 | $2,125.00 | $4,036.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,518.08 / $4,803.18 / $7,524.75
| Facility | | $2,518.08 | $4,803.18 | $7,524.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,606.67
| Facility | | $40.00 | $40.00 | $1,606.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,420.00 / $7,085.00
| Facility | | $746.00 | $2,420.00 | $7,085.00 |