- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.00 / $3,683.00 / $7,500.00
| Facility | | $682.00 | $3,683.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.21 / $1,878.12 / $2,967.41
| Facility | | $1,182.21 | $1,878.12 | $2,967.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.42 / $1,351.42 / $1,351.42
| Facility | | $1,351.42 | $1,351.42 | $1,351.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.86 / $566.01 / $1,618.08
| Facility | | $429.86 | $566.01 | $1,618.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.00 / $610.00 / $1,883.00
| Facility | | $139.00 | $610.00 | $1,883.00 |