- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $1,520.00 / $3,685.00
| Facility | | $443.91 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,038.93 / $3,868.27 / $5,717.16
| Facility | | $2,038.93 | $3,868.27 | $5,717.16 |
- 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
- $826.00 / $2,653.00 / $6,661.00
| Facility | | $826.00 | $2,653.00 | $6,661.00 |