- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.88 / $1,850.00 / $3,884.00
| Facility | | $641.88 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,340.52 / $4,490.26 / $6,449.50
| Facility | | $2,340.52 | $4,490.26 | $6,449.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $497.24
| Facility | | $40.00 | $40.00 | $497.24 |
- 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
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |