- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.63 / $1,850.00 / $3,945.00
| Facility | | $640.63 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,353.52 / $2,804.56 / $5,523.68
| Facility | | $1,353.52 | $2,804.56 | $5,523.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.52 / $611.73 / $611.73
| Facility | | $477.52 | $611.73 | $611.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $1,200.00 / $1,200.00
| Facility | | $1,200.00 | $1,200.00 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |