- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.00 / $1,300.00 / $3,884.00
| Facility | | $497.00 | $1,300.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.83 / $1,962.39 / $2,657.13
| Facility | | $822.83 | $1,962.39 | $2,657.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.01 / $312.01 / $312.01
| Facility | | $312.01 | $312.01 | $312.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,948.00 / $5,948.00 / $5,948.00
| Facility | | $5,948.00 | $5,948.00 | $5,948.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $513.00 / $9,758.00
| Facility | | $194.00 | $513.00 | $9,758.00 |