- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.86 / $2,145.78 / $7,838.38
| Facility | | $271.86 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,835.94 / $6,357.37 / $9,865.12
| Facility | | $1,835.94 | $6,357.37 | $9,865.12 |
- 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
- $243.50 / $321.64 / $875.00
| Facility | | $243.50 | $321.64 | $875.00 |
- 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 |