- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.68 / $2,056.00 / $4,933.00
| Facility | | $157.68 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.31 / $590.94 / $924.17
| Facility | | $421.31 | $590.94 | $924.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.46 / $201.46 / $201.46
| Facility | | $201.46 | $201.46 | $201.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.80 / $2,807.30 / $4,933.00
| Facility | | $239.80 | $2,807.30 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $3,005.00 / $4,504.00
| Facility | | $773.00 | $3,005.00 | $4,504.00 |