- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.60 / $1,855.00 / $6,214.00
| Facility | | $359.60 | $1,855.00 | $6,214.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $3,395.00 / $5,737.00
| Facility | | $1,565.00 | $3,395.00 | $5,737.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $1,992.00 / $2,596.44
| Facility | | $455.00 | $1,992.00 | $2,596.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,139.62 / $10,639.60 / $16,394.00
| Facility | | $2,139.62 | $10,639.60 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,351.00 / $6,285.00
| Facility | | $1,000.00 | $3,351.00 | $6,285.00 |