- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.97 / $2,090.00 / $4,050.00
| Facility | | $537.97 | $2,090.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,534.06 / $4,490.26 / $6,449.50
| Facility | | $2,534.06 | $4,490.26 | $6,449.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $272.26
| Facility | | $40.00 | $40.00 | $272.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Facility | | $1,350.00 | $1,350.00 | $1,350.00 |
- 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 |