- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.00 / $1,273.00 / $3,500.00
| Facility | | $483.00 | $1,273.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,695.45 / $3,106.51 / $4,722.85
| Facility | | $1,695.45 | $3,106.51 | $4,722.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.10 / $275.10 / $275.10
| Facility | | $275.10 | $275.10 | $275.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $425.00 / $425.00
| Facility | | $425.00 | $425.00 | $425.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.00 / $2,652.00 / $6,585.00
| Facility | | $826.00 | $2,652.00 | $6,585.00 |