- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,418.00 / $4,509.00
| Facility | | $756.00 | $2,418.00 | $4,509.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,759.47 / $12,538.59 / $26,894.41
| Facility | | $4,759.47 | $12,538.59 | $26,894.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.76 / $391.76 / $391.76
| Facility | | $391.76 | $391.76 | $391.76 |
- 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
- $1,200.00 / $6,034.00 / $13,506.00
| Facility | | $1,200.00 | $6,034.00 | $13,506.00 |