- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.51 / $1,230.00 / $3,685.00
| Facility | | $416.51 | $1,230.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,416.25 / $3,063.05 / $5,754.41
| Facility | | $1,416.25 | $3,063.05 | $5,754.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.38 / $1,276.20 / $1,276.20
| Facility | | $319.38 | $1,276.20 | $1,276.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $425.00 / $425.00
| Facility | | $425.00 | $425.00 | $425.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,123.00
| Facility | | $470.00 | $1,429.00 | $4,123.00 |