- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.89 / $1,520.00 / $3,685.00
| Facility | | $483.89 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,574.62 / $3,116.18 / $6,755.64
| Facility | | $1,574.62 | $3,116.18 | $6,755.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.88 / $1,843.37 / $1,843.37
| Facility | | $358.88 | $1,843.37 | $1,843.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- 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 |