- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,850.00 / $3,945.00
| Facility | | $762.00 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,007.07 / $11,308.96 / $16,842.88
| Facility | | $6,007.07 | $11,308.96 | $16,842.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.41 / $520.41 / $520.41
| Facility | | $520.41 | $520.41 | $520.41 |
- 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
- $1,141.00 / $4,717.00 / $11,696.00
| Facility | | $1,141.00 | $4,717.00 | $11,696.00 |