- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.14 / $2,145.78 / $7,838.38
| Facility | | $504.14 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.88 / $5,688.84 / $8,827.71
| Facility | | $1,642.88 | $5,688.84 | $8,827.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $875.00
| Facility | | $875.00 | $875.00 | $875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.63 / $558.28 / $1,000.00
| Facility | | $471.63 | $558.28 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.00 / $5,971.00 / $8,422.00
| Facility | | $639.00 | $5,971.00 | $8,422.00 |