- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,418.00 / $4,392.00
| Facility | | $756.00 | $2,418.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,416.80 / $8,196.81 / $14,534.35
| Facility | | $4,416.80 | $8,196.81 | $14,534.35 |
- 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
- $848.00 / $848.00 / $848.00
| Facility | | $848.00 | $848.00 | $848.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $10,810.00
| Facility | | $1,141.00 | $4,717.00 | $10,810.00 |