- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.00 / $1,520.00 / $3,685.00
| Facility | | $508.00 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,263.04 / $4,044.56 / $6,593.78
| Facility | | $2,263.04 | $4,044.56 | $6,593.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.16 / $4,620.28 / $4,620.28
| Facility | | $291.16 | $4,620.28 | $4,620.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.54 / $650.00 / $2,599.03
| Facility | | $380.54 | $650.00 | $2,599.03 |
- 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 |