- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.70 / $1.70 / $1,000.00
| Facility | | $1.70 | $1.70 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,445.44 / $2,041.74
| Facility | | $676.08 | $1,445.44 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $489.78 / $891.25
| Facility | | $28.18 | $489.78 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $467.74
| Facility | | $407.38 | $407.38 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,445.44 / $2,884.03
| Facility | | $741.31 | $1,445.44 | $2,884.03 |