- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.00 / $1,300.00 / $3,685.00
| Facility | | $497.00 | $1,300.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,992.33 / $5,096.16 / $7,424.48
| Facility | | $2,992.33 | $5,096.16 | $7,424.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.80 / $2,553.21 / $2,553.21
| Facility | | $822.80 | $2,553.21 | $2,553.21 |
- 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
- $882.00 / $3,474.00 / $9,160.00
| Facility | | $882.00 | $3,474.00 | $9,160.00 |