- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.00 / $4,158.72 / $13,316.84
| Facility | | $677.00 | $4,158.72 | $13,316.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $2,710.28
| Facility | | $748.70 | $748.70 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.30 / $858.86 / $1,343.56
| Facility | | $661.30 | $858.86 | $1,343.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,541.67 / $8,957.00 / $26,542.00
| Facility | | $2,541.67 | $8,957.00 | $26,542.00 |