- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.33 / $1,520.00 / $3,685.00
| Facility | | $497.33 | $1,520.00 | $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 / $376.60
| Facility | | $40.00 | $40.00 | $376.60 |
- 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
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |