- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.93 / $2,747.00 / $12,865.42
| Facility | | $395.93 | $2,747.00 | $12,865.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $7,524.00 / $10,244.00
| Facility | | $2,807.00 | $7,524.00 | $10,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.14 / $503.92 / $581.30
| Facility | | $367.14 | $503.92 | $581.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.67 / $442.44 / $442.44
| Facility | | $415.67 | $442.44 | $442.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,069.00
| Facility | | $842.00 | $4,539.00 | $10,069.00 |