- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.25 / $1,965.00 / $6,060.00
| Facility | | $658.25 | $1,965.00 | $6,060.00 |
- 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
- $446.00 / $2,109.10 / $3,455.73
| Facility | | $446.00 | $2,109.10 | $3,455.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.15 / $466.14 / $3,008.00
| Facility | | $334.15 | $466.14 | $3,008.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.00 / $3,311.00 / $5,133.00
| Facility | | $845.00 | $3,311.00 | $5,133.00 |