- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.33 / $1,310.40 / $9,062.00
| Facility | | $587.33 | $1,310.40 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.00 / $1,382.39 / $3,203.38
| Facility | | $603.00 | $1,382.39 | $3,203.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $585.00 / $834.39
| Facility | | $375.00 | $585.00 | $834.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.51 / $769.52 / $1,069.84
| Facility | | $248.51 | $769.52 | $1,069.84 |
- 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 |