- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,570.40 / $6,025.60
| Facility | | $831.76 | $2,570.40 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,265.80 / $6,456.54
| Facility | | $2,238.72 | $4,265.80 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $3,388.44 / $3,388.44
| Facility | | $208.93 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,000.00 / $2,041.74
| Facility | | $389.05 | $1,000.00 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,398.83 / $6,606.93
| Facility | | $831.76 | $2,398.83 | $6,606.93 |