- 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
- $1,753.58 / $4,550.27 / $6,981.81
| Facility | | $1,753.58 | $4,550.27 | $6,981.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $813.15 / $1,345.41
| Facility | | $40.00 | $813.15 | $1,345.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $815.00 / $1,936.96
| Facility | | $725.00 | $815.00 | $1,936.96 |
- 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 |