- 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
- $3,326.08 / $6,913.21 / $12,095.98
| Facility | | $3,326.08 | $6,913.21 | $12,095.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.10 / $2,547.63 / $2,547.63
| Facility | | $297.10 | $2,547.63 | $2,547.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $425.00 / $425.00
| Facility | | $425.00 | $425.00 | $425.00 |
- 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 |