- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.82 / $1,029.64 / $9,727.00
| Facility | | $370.82 | $1,029.64 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.00 / $1,649.43 / $2,843.29
| Facility | | $780.00 | $1,649.43 | $2,843.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $2,106.17 / $2,706.47
| Facility | | $375.00 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.77 / $508.31 / $735.66
| Facility | | $345.77 | $508.31 | $735.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.00 / $3,866.00 / $6,584.00
| Facility | | $461.00 | $3,866.00 | $6,584.00 |