- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,418.00 / $4,050.00
| Facility | | $756.00 | $2,418.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,116.63 / $5,324.29 / $7,484.01
| Facility | | $3,116.63 | $5,324.29 | $7,484.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $915.02 / $915.02
| Facility | | $40.00 | $915.02 | $915.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $1,140.74
| Facility | | $488.00 | $675.00 | $1,140.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.00 / $3,588.00 / $9,160.00
| Facility | | $911.00 | $3,588.00 | $9,160.00 |