- 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
- $1,695.45 / $3,387.35 / $5,029.27
| Facility | | $1,695.45 | $3,387.35 | $5,029.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.68 / $1,517.41 / $1,517.41
| Facility | | $503.68 | $1,517.41 | $1,517.41 |
- 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 |