- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.55 / $1,520.00 / $3,593.00
| Facility | | $297.55 | $1,520.00 | $3,593.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,714.38 / $4,250.06 / $6,644.22
| Facility | | $1,714.38 | $4,250.06 | $6,644.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $125.03 / $1,342.02
| Facility | | $40.00 | $125.03 | $1,342.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.86 / $650.00 / $1,932.08
| Facility | | $236.86 | $650.00 | $1,932.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,661.00
| Facility | | $746.00 | $2,415.00 | $6,661.00 |