- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $2,636.00 / $4,543.28
| Facility | | $580.00 | $2,636.00 | $4,543.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.55 / $2,820.77 / $4,442.46
| Facility | | $1,336.55 | $2,820.77 | $4,442.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.00 / $1,604.81 / $1,604.81
| Facility | | $311.00 | $1,604.81 | $1,604.81 |
- 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
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |