- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.00 / $2,598.00 / $7,365.00
| Facility | | $1,184.00 | $2,598.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.00 / $1,508.00 / $3,523.00
| Facility | | $770.00 | $1,508.00 | $3,523.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,437.00 / $2,769.00 / $4,641.00
| Facility | | $2,437.00 | $2,769.00 | $4,641.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.13 / $847.42 / $4,304.60
| Facility | | $151.13 | $847.42 | $4,304.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $2,332.00 / $3,041.00
| Facility | | $1,300.00 | $2,332.00 | $3,041.00 |