- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.81 / $2,636.00 / $5,420.00
| Facility | | $866.81 | $2,636.00 | $5,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,908.30 / $3,977.32 / $6,263.93
| Facility | | $1,908.30 | $3,977.32 | $6,263.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.00 / $1,336.00 / $1,336.00
| Facility | | $1,336.00 | $1,336.00 | $1,336.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |