- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $2,529.00 / $6,060.00
| Facility | | $936.00 | $2,529.00 | $6,060.00 |
- 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
- $1,459.33 / $1,459.33 / $1,459.33
| Facility | | $1,459.33 | $1,459.33 | $1,459.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.15 / $359.89 / $2,017.00
| Facility | | $169.15 | $359.89 | $2,017.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,578.00 / $2,567.00 / $5,029.00
| Facility | | $1,578.00 | $2,567.00 | $5,029.00 |