- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.42 / $1,924.00 / $9,311.00
| Facility | | $459.42 | $1,924.00 | $9,311.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $3,967.00 / $8,800.00
| Facility | | $2,088.00 | $3,967.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.76 / $620.05 / $715.29
| Facility | | $451.76 | $620.05 | $715.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.70 / $545.70 / $545.70
| Facility | | $545.70 | $545.70 | $545.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $945.00 / $6,295.00
| Facility | | $575.00 | $945.00 | $6,295.00 |