- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $1,520.00 / $3,685.00
| Facility | | $593.00 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,753.58 / $3,827.62 / $5,737.44
| Facility | | $1,753.58 | $3,827.62 | $5,737.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $538.03 / $1,345.41
| Facility | | $40.00 | $538.03 | $1,345.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.00 / $650.00 / $1,936.96
| Facility | | $615.00 | $650.00 | $1,936.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,010.00
| Facility | | $470.00 | $1,429.00 | $4,010.00 |