- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.00 / $2,736.07 / $6,483.00
| Facility | | $808.00 | $2,736.07 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.79 / $2,064.02 / $3,616.69
| Facility | | $552.79 | $2,064.02 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.02 / $565.99 / $927.38
| Facility | | $428.02 | $565.99 | $927.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.82 / $359.92 / $764.00
| Facility | | $138.82 | $359.92 | $764.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.00 / $2,517.00 / $4,486.00
| Facility | | $966.00 | $2,517.00 | $4,486.00 |