- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $2,630.27
| Facility | | $263.03 | $263.03 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,890.45 / $8,912.51
| Facility | | $1,584.89 | $3,890.45 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,000.00 / $2,344.23
| Facility | | $707.95 | $1,000.00 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $977.24 / $1,862.09
| Facility | | $758.58 | $977.24 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $562.34 / $5,011.87
| Facility | | $288.40 | $562.34 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,548.13 / $8,912.51
| Facility | | $1,584.89 | $3,548.13 | $8,912.51 |