- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.47 / $2,255.00 / $5,634.00
| Facility | | $156.47 | $2,255.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $4,880.00 / $8,240.00
| Facility | | $800.00 | $4,880.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.80 / $186.94 / $2,767.86
| Facility | | $143.80 | $186.94 | $2,767.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.25 / $761.00 / $848.27
| Facility | | $269.25 | $761.00 | $848.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,817.00 / $5,402.00
| Facility | | $900.00 | $3,817.00 | $5,402.00 |