- 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
- $2,551.50 / $4,725.68 / $7,472.37
| Facility | | $2,551.50 | $4,725.68 | $7,472.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $733.62 / $733.62
| Facility | | $40.00 | $733.62 | $733.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $1,100.00
| Facility | | $488.00 | $675.00 | $1,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.00 / $2,415.00 / $6,661.00
| Facility | | $689.00 | $2,415.00 | $6,661.00 |