- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,958.00 / $4,697.00
| Facility | | $762.00 | $1,958.00 | $4,697.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.40 / $5,047.04 / $7,775.04
| Facility | | $2,699.40 | $5,047.04 | $7,775.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.32 / $3,388.32 / $3,388.32
| Facility | | $570.32 | $3,388.32 | $3,388.32 |
- 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
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |