- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.00 / $1,850.00 / $5,360.12
| Facility | | $678.00 | $1,850.00 | $5,360.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,839.21 / $3,591.37 / $5,260.65
| Facility | | $1,839.21 | $3,591.37 | $5,260.65 |
- 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
- $689.00 / $689.00 / $689.00
| Facility | | $689.00 | $689.00 | $689.00 |
- 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 |