- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.58 / $2,662.76 / $9,062.00
| Facility | | $457.58 | $2,662.76 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,690.15 / $2,881.26 / $4,989.60
| Facility | | $1,690.15 | $2,881.26 | $4,989.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.67 / $378.67 / $378.67
| Facility | | $378.67 | $378.67 | $378.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.78 / $280.00 / $424.75
| Facility | | $165.78 | $280.00 | $424.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.00 / $3,866.00 / $6,584.00
| Facility | | $461.00 | $3,866.00 | $6,584.00 |