- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,513.56 / $5,495.41
| Facility | | $588.84 | $1,513.56 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,454.71 / $4,365.16
| Facility | | $1,584.89 | $2,454.71 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $741.31 / $954.99
| Facility | | $537.03 | $741.31 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,659.59
| Facility | | $1,000.00 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,754.23 / $6,309.57
| Facility | | $602.56 | $2,754.23 | $6,309.57 |