- 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
- $2,297.79 / $4,340.72 / $6,151.55
| Facility | | $2,297.79 | $4,340.72 | $6,151.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.64 / $2,143.41 / $2,143.41
| Facility | | $574.64 | $2,143.41 | $2,143.41 |
- 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
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |