- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.00 / $1,175.00 / $3,482.51
| Facility | | $679.00 | $1,175.00 | $3,482.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.81 / $3,374.53 / $5,663.39
| Facility | | $2,100.81 | $3,374.53 | $5,663.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.37 / $1,509.60 / $2,855.89
| Facility | | $874.37 | $1,509.60 | $2,855.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,173.42 / $3,834.36 / $6,025.97
| Facility | | $2,173.42 | $3,834.36 | $6,025.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $1,837.00 / $5,633.76
| Facility | | $750.00 | $1,837.00 | $5,633.76 |