- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,876.00 / $7,500.00
| Facility | | $625.00 | $2,876.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.15 / $558.45 / $756.27
| Facility | | $502.15 | $558.45 | $756.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.25 / $1,070.25 / $1,070.25
| Facility | | $1,070.25 | $1,070.25 | $1,070.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.79 / $637.84 / $5,477.56
| Facility | | $325.79 | $637.84 | $5,477.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,875.93 / $5,543.93
| Facility | | $884.00 | $2,875.93 | $5,543.93 |