- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.71 / $3,772.65 / $12,312.46
| Facility | | $628.71 | $3,772.65 | $12,312.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,171.14 / $4,419.60 / $9,143.61
| Facility | | $1,171.14 | $4,419.60 | $9,143.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $655.00 / $1,842.86
| Facility | | $375.00 | $655.00 | $1,842.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.69 / $278.02 / $503.88
| Facility | | $140.69 | $278.02 | $503.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.00 / $9,663.00 / $16,249.00
| Facility | | $791.00 | $9,663.00 | $16,249.00 |