- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,850.00 / $3,945.00
| Facility | | $580.00 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,648.96 / $3,058.43 / $7,476.46
| Facility | | $1,648.96 | $3,058.43 | $7,476.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.37 / $1,206.75 / $1,206.75
| Facility | | $382.37 | $1,206.75 | $1,206.75 |
- 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
- $826.00 / $2,423.00 / $6,585.00
| Facility | | $826.00 | $2,423.00 | $6,585.00 |