- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.50 / $2,447.00 / $5,150.00
| Facility | | $748.50 | $2,447.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,344.75 / $9,738.61 / $14,756.27
| Facility | | $3,344.75 | $9,738.61 | $14,756.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $953.96
| Facility | | $40.00 | $40.00 | $953.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.00 / $1,802.00 / $1,802.00
| Facility | | $1,802.00 | $1,802.00 | $1,802.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,474.00 / $9,160.00
| Facility | | $882.00 | $3,474.00 | $9,160.00 |