- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.52 / $1,850.00 / $3,884.00
| Facility | | $545.52 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,215.93 / $6,261.91 / $13,151.92
| Facility | | $3,215.93 | $6,261.91 | $13,151.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $320.69
| Facility | | $40.00 | $40.00 | $320.69 |
- 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
- $826.00 / $2,652.00 / $7,611.00
| Facility | | $826.00 | $2,652.00 | $7,611.00 |