- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.00 / $1,850.00 / $3,884.00
| Facility | | $738.00 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,419.07 / $4,629.75 / $6,849.11
| Facility | | $2,419.07 | $4,629.75 | $6,849.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.38 / $302.38 / $591.52
| Facility | | $302.38 | $302.38 | $591.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.20 / $731.00 / $2,711.98
| Facility | | $714.20 | $731.00 | $2,711.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $8,488.00
| Facility | | $882.00 | $3,238.00 | $8,488.00 |