- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.00 / $1,958.00 / $4,392.00
| Facility | | $445.00 | $1,958.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.25 / $1,939.93 / $3,571.74
| Facility | | $1,081.25 | $1,939.93 | $3,571.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.62 / $1,552.06 / $1,552.06
| Facility | | $195.62 | $1,552.06 | $1,552.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.48 / $731.00 / $1,197.32
| Facility | | $253.48 | $731.00 | $1,197.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,791.00 / $4,251.00
| Facility | | $500.00 | $1,791.00 | $4,251.00 |