- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.04 / $1,305.00 / $5,216.00
| Facility | | $452.04 | $1,305.00 | $5,216.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,316.23 / $3,316.23 / $3,780.50
| Facility | | $3,316.23 | $3,316.23 | $3,780.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.97 / $457.23 / $560.55
| Facility | | $331.97 | $457.23 | $560.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $515.00 / $2,281.67
| Facility | | $490.00 | $515.00 | $2,281.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $1,461.00 / $3,384.00
| Facility | | $750.00 | $1,461.00 | $3,384.00 |