- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,520.00 / $3,685.00
| Facility | | $580.00 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.54 / $5,907.14 / $10,692.30
| Facility | | $2,712.54 | $5,907.14 | $10,692.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.55 / $2,650.74 / $2,650.74
| Facility | | $509.55 | $2,650.74 | $2,650.74 |
- 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 |