- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,758.00 / $5,432.00
| Facility | | $941.00 | $2,758.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,993.76 / $4,095.68 / $6,263.93
| Facility | | $1,993.76 | $4,095.68 | $6,263.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $723.55 / $723.55 / $723.55
| Facility | | $723.55 | $723.55 | $723.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.00 / $1,336.00 / $1,336.00
| Facility | | $1,336.00 | $1,336.00 | $1,336.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |