- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.94 / $1,850.00 / $3,945.00
| Facility | | $670.94 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,601.67 / $5,047.04 / $7,123.70
| Facility | | $2,601.67 | $5,047.04 | $7,123.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $490.80
| Facility | | $40.00 | $40.00 | $490.80 |
- 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 |