- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $2,912.00 / $6,483.00
| Facility | | $936.00 | $2,912.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,197.38 / $3,616.69
| Facility | | $587.35 | $2,197.38 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,833.49 / $2,833.49 / $2,833.49
| Facility | | $2,833.49 | $2,833.49 | $2,833.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.50 / $473.12 / $3,339.00
| Facility | | $339.50 | $473.12 | $3,339.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |