- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.84 / $1,520.00 / $3,685.00
| Facility | | $354.84 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,908.30 / $3,728.94 / $5,325.91
| Facility | | $1,908.30 | $3,728.94 | $5,325.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,668.38 / $1,668.38 / $1,668.38
| Facility | | $1,668.38 | $1,668.38 | $1,668.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $600.00 / $600.00
| Facility | | $600.00 | $600.00 | $600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |