- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $3,232.00 / $10,439.00
| Facility | | $800.00 | $3,232.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.77 / $1,039.77 / $1,039.77
| Facility | | $1,039.77 | $1,039.77 | $1,039.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.00 / $993.00 / $1,098.00
| Facility | | $596.00 | $993.00 | $1,098.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.51 / $832.36 / $1,741.47
| Facility | | $151.51 | $832.36 | $1,741.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.00 / $2,081.00 / $3,918.00
| Facility | | $816.00 | $2,081.00 | $3,918.00 |