- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.96 / $1,520.00 / $3,685.00
| Facility | | $507.96 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,371.17 / $4,548.21 / $6,578.64
| Facility | | $2,371.17 | $4,548.21 | $6,578.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.91 / $3,220.21 / $3,220.21
| Facility | | $380.91 | $3,220.21 | $3,220.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |