- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $1,850.00 / $3,945.00
| Facility | | $443.91 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,068.71 / $8,166.72 / $11,471.36
| Facility | | $2,068.71 | $8,166.72 | $11,471.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $87.95
| Facility | | $40.00 | $40.00 | $87.95 |
- 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
- $194.00 / $543.00 / $1,560.00
| Facility | | $194.00 | $543.00 | $1,560.00 |