- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.48 / $1,520.00 / $3,884.00
| Facility | | $513.48 | $1,520.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,263.04 / $4,153.34 / $6,593.78
| Facility | | $2,263.04 | $4,153.34 | $6,593.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.67 / $2,934.10 / $2,934.10
| Facility | | $306.67 | $2,934.10 | $2,934.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.86 / $650.00 / $2,599.03
| Facility | | $400.86 | $650.00 | $2,599.03 |
- 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 |