- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.12 / $3,158.00 / $10,439.00
| Facility | | $506.12 | $3,158.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.05 / $1,175.39 / $1,592.44
| Facility | | $683.05 | $1,175.39 | $1,592.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.00 / $744.00 / $744.00
| Facility | | $596.00 | $744.00 | $744.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.29 / $432.12 / $1,322.30
| Facility | | $178.29 | $432.12 | $1,322.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.00 / $2,081.00 / $3,918.00
| Facility | | $816.00 | $2,081.00 | $3,918.00 |