- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.00 / $2,132.92 / $7,796.00
| Facility | | $549.00 | $2,132.92 | $7,796.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.35 / $2,851.56 / $5,557.02
| Facility | | $1,146.35 | $2,851.56 | $5,557.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $933.68
| Facility | | $375.00 | $615.00 | $933.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.75 / $1,037.09 / $1,547.43
| Facility | | $229.75 | $1,037.09 | $1,547.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.00 / $6,172.00 / $8,667.00
| Facility | | $586.00 | $6,172.00 | $8,667.00 |