- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.65 / $1,614.00 / $4,861.70
| Facility | | $504.65 | $1,614.00 | $4,861.70 |
- 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
- $312.58 / $3,709.79 / $3,709.79
| Facility | | $312.58 | $3,709.79 | $3,709.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.89 / $650.00 / $2,599.03
| Facility | | $408.89 | $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 |