- 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
- $2,972.60 / $5,155.64 / $7,249.45
| Facility | | $2,972.60 | $5,155.64 | $7,249.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.77 / $3,559.06 / $3,559.06
| Facility | | $637.77 | $3,559.06 | $3,559.06 |
- 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
- $746.00 / $2,420.00 / $7,085.00
| Facility | | $746.00 | $2,420.00 | $7,085.00 |