- 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
- $3,588.66 / $8,437.98 / $12,356.34
| Facility | | $3,588.66 | $8,437.98 | $12,356.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $545.08 / $2,807.66
| Facility | | $40.00 | $545.08 | $2,807.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.56 / $731.00 / $4,042.13
| Facility | | $716.56 | $731.00 | $4,042.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $5,414.00 / $11,831.32
| Facility | | $1,141.00 | $5,414.00 | $11,831.32 |