- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.41 / $3,232.00 / $10,439.00
| Facility | | $610.41 | $3,232.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.20 / $1,450.76 / $2,299.67
| Facility | | $984.20 | $1,450.76 | $2,299.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.00 / $330.00 / $330.00
| Facility | | $330.00 | $330.00 | $330.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.58 / $641.33 / $1,374.79
| Facility | | $446.58 | $641.33 | $1,374.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.00 / $550.00 / $1,769.00
| Facility | | $191.00 | $550.00 | $1,769.00 |