- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.88 / $3,745.00 / $7,525.55
| Facility | | $1,036.88 | $3,745.00 | $7,525.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.79 / $2,362.71 / $4,140.09
| Facility | | $632.79 | $2,362.71 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.00 / $1,571.83 / $2,575.42
| Facility | | $510.00 | $1,571.83 | $2,575.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.08 / $545.01 / $1,129.36
| Facility | | $376.08 | $545.01 | $1,129.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.00 / $3,311.00 / $5,133.00
| Facility | | $845.00 | $3,311.00 | $5,133.00 |