- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.46 / $1,958.00 / $4,559.00
| Facility | | $619.46 | $1,958.00 | $4,559.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,601.67 / $4,822.02 / $7,653.66
| Facility | | $2,601.67 | $4,822.02 | $7,653.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $454.18
| Facility | | $40.00 | $40.00 | $454.18 |
- 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
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |