- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.64 / $2,397.00 / $4,392.00
| Facility | | $620.64 | $2,397.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $4,782.75 / $6,595.65
| Facility | | $2,699.40 | $4,782.75 | $6,595.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $454.84
| Facility | | $40.00 | $40.00 | $454.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- 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 |