- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,574.00 / $5,718.57
| Facility | | $900.00 | $2,574.00 | $5,718.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,516.71 / $8,644.12 / $12,798.33
| Facility | | $3,516.71 | $8,644.12 | $12,798.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.45 / $5,085.95 / $5,085.95
| Facility | | $633.45 | $5,085.95 | $5,085.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $3,963.12
| Facility | | $488.00 | $675.00 | $3,963.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.00 / $7,066.48 / $13,914.43
| Facility | | $1,284.00 | $7,066.48 | $13,914.43 |