- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,372.00 / $3,685.00
| Facility | | $400.00 | $1,372.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,739.66 / $6,018.56 / $10,692.30
| Facility | | $2,739.66 | $6,018.56 | $10,692.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $271.27
| Facility | | $40.00 | $40.00 | $271.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.00 / $2,918.00 / $7,738.10
| Facility | | $826.00 | $2,918.00 | $7,738.10 |