- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.75 / $2,056.00 / $4,933.00
| Facility | | $204.75 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,170.12 / $2,591.27 / $3,664.01
| Facility | | $2,170.12 | $2,591.27 | $3,664.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.43 / $257.43 / $257.43
| Facility | | $257.43 | $257.43 | $257.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.61 / $2,056.00 / $4,933.00
| Facility | | $537.61 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.00 / $1,438.00 / $2,029.00
| Facility | | $464.00 | $1,438.00 | $2,029.00 |