- 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
- $2,601.67 / $5,510.21 / $10,332.54
| Facility | | $2,601.67 | $5,510.21 | $10,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.75 / $2,267.04 / $2,267.04
| Facility | | $749.75 | $2,267.04 | $2,267.04 |
- 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
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |