- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.45 / $2,107.58 / $8,442.00
| Facility | | $397.45 | $2,107.58 | $8,442.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.45 / $1,814.66 / $2,329.78
| Facility | | $397.45 | $1,814.66 | $2,329.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,470.62 / $9,447.00 / $14,257.00
| Facility | | $2,470.62 | $9,447.00 | $14,257.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,187.68 / $3,187.68
| Facility | | $55.00 | $3,187.68 | $3,187.68 |