- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.40 / $1,304.76 / $5,355.67
| Facility | | $359.40 | $1,304.76 | $5,355.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,498.00 / $8,517.00
| Facility | | $1,643.00 | $3,498.00 | $8,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.55 / $457.42 / $539.80
| Facility | | $334.55 | $457.42 | $539.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.17 / $601.17 / $601.17
| Facility | | $601.17 | $601.17 | $601.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $15,075.00
| Facility | | $973.00 | $4,639.00 | $15,075.00 |