- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.63 / $1,217.59 / $7,212.00
| Facility | | $251.63 | $1,217.59 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $5,757.57 / $8,388.00
| Facility | | $800.00 | $5,757.57 | $8,388.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.27 / $300.64 / $1,483.99
| Facility | | $231.27 | $300.64 | $1,483.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.76 / $761.00 / $1,158.10
| Facility | | $436.76 | $761.00 | $1,158.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,817.00 / $5,402.00
| Facility | | $900.00 | $3,817.00 | $5,402.00 |