- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.83 / $2,549.00 / $6,818.00
| Facility | | $423.83 | $2,549.00 | $6,818.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.49 / $4,278.33 / $6,461.26
| Facility | | $1,565.49 | $4,278.33 | $6,461.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.95 / $2,782.24 / $2,782.24
| Facility | | $265.95 | $2,782.24 | $2,782.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.02 / $1,026.00 / $1,932.08
| Facility | | $346.02 | $1,026.00 | $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 |