- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $1,869.00 / $5,141.72
| Facility | | $612.00 | $1,869.00 | $5,141.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,753.58 / $4,539.27 / $6,981.81
| Facility | | $1,753.58 | $4,539.27 | $6,981.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.05 / $2,696.40 / $2,696.40
| Facility | | $413.05 | $2,696.40 | $2,696.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.56 / $731.00 / $1,936.96
| Facility | | $715.56 | $731.00 | $1,936.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.00 / $2,889.00 / $6,661.00
| Facility | | $826.00 | $2,889.00 | $6,661.00 |