- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.05 / $1,820.35 / $10,032.00
| Facility | | $317.05 | $1,820.35 | $10,032.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.00 / $837.00 / $3,611.43
| Facility | | $448.00 | $837.00 | $3,611.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $1,139.16
| Facility | | $375.00 | $615.00 | $1,139.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.25 / $382.34 / $556.21
| Facility | | $279.25 | $382.34 | $556.21 |
- 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 |