- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $3,576.00 / $7,500.00
| Facility | | $760.00 | $3,576.00 | $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
- $284.45 / $1,519.00 / $5,819.45
| Facility | | $284.45 | $1,519.00 | $5,819.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $3,317.00 / $5,558.80
| Facility | | $884.00 | $3,317.00 | $5,558.80 |