- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.52 / $5,247.03 / $15,604.48
| Facility | | $490.52 | $5,247.03 | $15,604.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,453.87 / $5,060.37 / $8,705.65
| Facility | | $2,453.87 | $5,060.37 | $8,705.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $580.00 / $1,370.63
| Facility | | $375.00 | $580.00 | $1,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.83 / $529.41 / $842.46
| Facility | | $381.83 | $529.41 | $842.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.00 / $6,607.00 / $8,667.00
| Facility | | $729.00 | $6,607.00 | $8,667.00 |