- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.06 / $1,850.00 / $4,050.00
| Facility | | $721.06 | $1,850.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $5,144.76 / $7,311.11
| Facility | | $2,699.40 | $5,144.76 | $7,311.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $531.78
| Facility | | $40.00 | $40.00 | $531.78 |
- 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 |