- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.94 / $2,877.00 / $4,933.00
| Facility | | $162.94 | $2,877.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,266.32 / $2,673.33 / $3,761.18
| Facility | | $2,266.32 | $2,673.33 | $3,761.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.63 / $207.63 / $207.63
| Facility | | $207.63 | $207.63 | $207.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.00 / $2,877.00 / $4,933.00
| Facility | | $528.00 | $2,877.00 | $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 |