- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.63 / $1,295.00 / $3,804.00
| Facility | | $206.63 | $1,295.00 | $3,804.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.19 / $1,513.19 / $1,815.83
| Facility | | $1,513.19 | $1,513.19 | $1,815.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.27 / $225.27 / $225.27
| Facility | | $225.27 | $225.27 | $225.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.25 / $560.25 / $560.25
| Facility | | $560.25 | $560.25 | $560.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.00 / $811.00 / $2,285.00
| Facility | | $330.00 | $811.00 | $2,285.00 |