- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.37 / $787.00 / $5,320.00
| Facility | | $306.37 | $787.00 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,316.00 / $4,389.00
| Facility | | $1,258.00 | $2,316.00 | $4,389.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.91 / $482.64 / $556.76
| Facility | | $338.91 | $482.64 | $556.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.52 / $428.52 / $542.63
| Facility | | $428.52 | $428.52 | $542.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $2,723.00 / $6,295.00
| Facility | | $599.00 | $2,723.00 | $6,295.00 |