- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.87 / $1,850.00 / $3,945.00
| Facility | | $688.87 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,371.17 / $4,946.92 / $7,123.70
| Facility | | $2,371.17 | $4,946.92 | $7,123.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $528.38
| Facility | | $40.00 | $40.00 | $528.38 |
- 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 |