- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $1,520.00 / $3,728.00
| Facility | | $646.00 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,518.08 / $4,407.91 / $6,259.61
| Facility | | $2,518.08 | $4,407.91 | $6,259.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.42 / $2,185.98 / $2,185.98
| Facility | | $861.42 | $2,185.98 | $2,185.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |