- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,089.30 / $6,760.83
| Facility | | $870.96 | $2,089.30 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,754.40 / $9,120.11
| Facility | | $3,715.35 | $5,754.40 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,000.00 / $5,888.44
| Facility | | $575.44 | $1,000.00 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,089.30 / $4,073.80
| Facility | | $575.44 | $2,089.30 | $4,073.80 |