- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.98 / $1,524.00 / $3,685.00
| Facility | | $610.98 | $1,524.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,826.85 / $3,915.25 / $5,798.09
| Facility | | $1,826.85 | $3,915.25 | $5,798.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.57 / $432.57 / $1,345.41
| Facility | | $432.57 | $432.57 | $1,345.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $525.00 / $1,936.96
| Facility | | $488.00 | $525.00 | $1,936.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.00 / $2,415.00 / $6,661.00
| Facility | | $689.00 | $2,415.00 | $6,661.00 |