- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.13 / $1,850.00 / $3,945.00
| Facility | | $658.13 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,695.45 / $3,375.43 / $5,029.27
| Facility | | $1,695.45 | $3,375.43 | $5,029.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $425.85
| Facility | | $40.00 | $40.00 | $425.85 |
- 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
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |