- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.86 / $1,145.36 / $5,320.00
| Facility | | $546.86 | $1,145.36 | $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
- $596.15 / $853.24 / $984.28
| Facility | | $596.15 | $853.24 | $984.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.45 / $745.45 / $1,127.82
| Facility | | $745.45 | $745.45 | $1,127.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $3,828.00 / $8,582.00
| Facility | | $739.00 | $3,828.00 | $8,582.00 |