- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.74 / $1,273.00 / $3,500.00
| Facility | | $387.74 | $1,273.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,045.03 / $4,646.10 / $6,948.45
| Facility | | $1,045.03 | $4,646.10 | $6,948.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.72 / $2,952.14 / $2,952.14
| Facility | | $219.72 | $2,952.14 | $2,952.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.85 / $488.00 / $815.00
| Facility | | $368.85 | $488.00 | $815.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,010.00
| Facility | | $470.00 | $1,429.00 | $4,010.00 |