- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.85 / $1,520.00 / $3,728.00
| Facility | | $428.85 | $1,520.00 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,628.57 / $2,719.67 / $4,069.57
| Facility | | $1,628.57 | $2,719.67 | $4,069.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.50 / $1,747.80 / $1,747.80
| Facility | | $272.50 | $1,747.80 | $1,747.80 |
- 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 |