- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.91 / $1,520.00 / $3,685.00
| Facility | | $586.91 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,714.38 / $4,081.90 / $6,007.08
| Facility | | $1,714.38 | $4,081.90 | $6,007.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $376.11 / $1,342.02
| Facility | | $40.00 | $376.11 | $1,342.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.29 / $650.00 / $1,932.08
| Facility | | $492.29 | $650.00 | $1,932.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,661.00
| Facility | | $746.00 | $2,415.00 | $6,661.00 |