- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.62 / $3,770.23 / $7,686.00
| Facility | | $631.62 | $3,770.23 | $7,686.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $1,362.98 / $2,709.73
| Facility | | $515.00 | $1,362.98 | $2,709.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.85 / $557.63 / $926.33
| Facility | | $414.85 | $557.63 | $926.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,208.00 / $9,324.00
| Facility | | $773.00 | $1,208.00 | $9,324.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,931.12 / $2,931.12 / $26,542.00
| Facility | | $2,931.12 | $2,931.12 | $26,542.00 |