- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,850.00 / $4,050.00
| Facility | | $762.00 | $1,850.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.18 / $5,285.10 / $7,790.59
| Facility | | $2,884.18 | $5,285.10 | $7,790.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.20 / $2,467.83 / $2,467.83
| Facility | | $623.20 | $2,467.83 | $2,467.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,200.00 / $1,200.00
| Facility | | $1,200.00 | $1,200.00 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |