- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.31 / $4,230.00 / $9,727.00
| Facility | | $320.31 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.26 / $1,093.77 / $1,765.12
| Facility | | $615.26 | $1,093.77 | $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
- $291.33 / $491.00 / $704.85
| Facility | | $291.33 | $491.00 | $704.85 |
- 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 |