- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,562.00 / $3,884.00
| Facility | | $900.00 | $2,562.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,756.08 / $5,128.38 / $7,412.26
| Facility | | $2,756.08 | $5,128.38 | $7,412.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $1,256.54 / $1,256.54
| Facility | | $40.00 | $1,256.54 | $1,256.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $1,585.76
| Facility | | $488.00 | $675.00 | $1,585.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,261.00 / $7,168.00
| Facility | | $385.00 | $1,261.00 | $7,168.00 |