- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.91 / $2,827.30 / $5,621.00
| Facility | | $358.91 | $2,827.30 | $5,621.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.59 / $1,349.02 / $3,277.99
| Facility | | $625.59 | $1,349.02 | $3,277.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $585.00 / $1,139.16
| Facility | | $375.00 | $585.00 | $1,139.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.04 / $377.82 / $546.76
| Facility | | $263.04 | $377.82 | $546.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.00 / $6,172.00 / $8,667.00
| Facility | | $586.00 | $6,172.00 | $8,667.00 |