- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.33 / $5,000.27 / $7,838.38
| Facility | | $687.33 | $5,000.27 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.20 / $3,073.55 / $4,946.74
| Facility | | $791.20 | $3,073.55 | $4,946.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.00 / $357.00 / $749.86
| Facility | | $357.00 | $357.00 | $749.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.44 / $595.44 / $936.08
| Facility | | $219.44 | $595.44 | $936.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $3,085.00 / $5,060.00
| Facility | | $755.00 | $3,085.00 | $5,060.00 |