- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.47 / $3,307.00 / $7,996.00
| Facility | | $936.47 | $3,307.00 | $7,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.00 / $591.00 / $1,135.71
| Facility | | $591.00 | $591.00 | $1,135.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.50 / $1,644.00 / $26,542.00
| Facility | | $585.50 | $1,644.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,833.00 / $5,813.00
| Facility | | $1,438.00 | $2,833.00 | $5,813.00 |