- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.94 / $2,636.00 / $5,185.79
| Facility | | $672.94 | $2,636.00 | $5,185.79 |
- 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
- $469.19 / $2,708.38 / $2,708.38
| Facility | | $469.19 | $2,708.38 | $2,708.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.70 / $901.00 / $1,936.96
| Facility | | $545.70 | $901.00 | $1,936.96 |
- 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 |