- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,778.28 / $2,818.38
| Facility | | $630.96 | $1,778.28 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,801.89 / $8,511.38
| Facility | | $2,344.23 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $741.31 / $954.99
| Facility | | $549.54 | $741.31 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,862.09
| Facility | | $1,000.00 | $1,000.00 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,890.45 / $8,511.38
| Facility | | $741.31 | $3,890.45 | $8,511.38 |