- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.00 / $2,897.00 / $6,483.00
| Facility | | $808.00 | $2,897.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.16 / $2,465.48 / $3,846.60
| Facility | | $601.16 | $2,465.48 | $3,846.60 |
- 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
- $189.01 / $401.56 / $1,643.00
| Facility | | $189.01 | $401.56 | $1,643.00 |
- 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 |