- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $1,544.00 / $3,685.00
| Facility | | $443.91 | $1,544.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,122.40 / $6,215.26 / $10,133.64
| Facility | | $3,122.40 | $6,215.26 | $10,133.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $224.41 / $1,621.81
| Facility | | $40.00 | $224.41 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $525.00 / $2,425.00
| Facility | | $443.00 | $525.00 | $2,425.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.00 / $3,238.00 / $8,488.00
| Facility | | $868.00 | $3,238.00 | $8,488.00 |