- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.29 / $9,062.00 / $18,276.00
| Facility | | $609.29 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.40 / $1,689.74 / $2,843.29
| Facility | | $966.40 | $1,689.74 | $2,843.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $1,221.33 / $1,569.43
| Facility | | $715.00 | $1,221.33 | $1,569.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.33 / $646.26 / $1,082.85
| Facility | | $494.33 | $646.26 | $1,082.85 |
- 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 |