- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.03 / $2,464.00 / $5,506.00
| Facility | | $526.03 | $2,464.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.80 / $1,541.29 / $2,700.74
| Facility | | $412.80 | $1,541.29 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.00 / $711.68 / $1,166.08
| Facility | | $333.00 | $711.68 | $1,166.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.96 / $254.90 / $569.07
| Facility | | $103.96 | $254.90 | $569.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.00 / $2,517.00 / $4,486.00
| Facility | | $966.00 | $2,517.00 | $4,486.00 |