- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.23 / $5,621.00 / $9,727.00
| Facility | | $299.23 | $5,621.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $618.30 / $1,079.52 / $1,765.12
| Facility | | $618.30 | $1,079.52 | $1,765.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.39 / $617.39 / $617.39
| Facility | | $617.39 | $617.39 | $617.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.27 / $424.04 / $641.58
| Facility | | $267.27 | $424.04 | $641.58 |
- 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 |