- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.00 / $1,850.00 / $3,884.00
| Facility | | $598.00 | $1,850.00 | $3,884.00 |
- 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
- $325.10 / $3,242.16 / $3,242.16
| Facility | | $325.10 | $3,242.16 | $3,242.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.97 / $525.00 / $2,599.03
| Facility | | $424.97 | $525.00 | $2,599.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.00 / $2,415.00 / $6,661.00
| Facility | | $689.00 | $2,415.00 | $6,661.00 |