- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $2,640.00 / $5,506.00
| Facility | | $936.00 | $2,640.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.92 / $1,783.81 / $2,700.74
| Facility | | $448.92 | $1,783.81 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.05 / $1,165.05 / $1,165.05
| Facility | | $1,165.05 | $1,165.05 | $1,165.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.92 / $200.87 / $2,649.00
| Facility | | $97.92 | $200.87 | $2,649.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.00 / $1,958.00 / $3,268.00
| Facility | | $1,068.00 | $1,958.00 | $3,268.00 |