- 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
- $2,291.73 / $5,206.28 / $7,741.01
| Facility | | $2,291.73 | $5,206.28 | $7,741.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $964.28 / $964.28
| Facility | | $40.00 | $964.28 | $964.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $1,192.73
| Facility | | $488.00 | $675.00 | $1,192.73 |
- 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 |