- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.00 / $2,033.00 / $2,590.58
| Facility | | $932.00 | $2,033.00 | $2,590.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.18 / $771.55 / $1,256.25
| Facility | | $276.18 | $771.55 | $1,256.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.22 / $237.30 / $388.23
| Facility | | $140.22 | $237.30 | $388.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.00 / $2,083.00 / $2,314.00
| Facility | | $957.00 | $2,083.00 | $2,314.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.54 / $1,336.78 / $3,531.11
| Facility | | $562.54 | $1,336.78 | $3,531.11 |