- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $2,536.00 / $7,500.00
| Facility | | $760.00 | $2,536.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,646.01 / $4,944.21 / $7,161.81
| Facility | | $3,646.01 | $4,944.21 | $7,161.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.76 / $335.76 / $335.76
| Facility | | $335.76 | $335.76 | $335.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.94 / $871.04 / $2,054.32
| Facility | | $288.94 | $871.04 | $2,054.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.00 / $610.00 / $1,883.00
| Facility | | $139.00 | $610.00 | $1,883.00 |