- 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
- $4,730.38 / $8,970.89 / $13,753.10
| Facility | | $4,730.38 | $8,970.89 | $13,753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.42 / $1,554.40 / $1,554.40
| Facility | | $795.42 | $1,554.40 | $1,554.40 |
- 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 |