- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.87 / $2,292.00 / $10,635.00
| Facility | | $227.87 | $2,292.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $2,114.00 / $8,800.00
| Facility | | $918.00 | $2,114.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.21 / $176.65 / $218.64
| Facility | | $147.21 | $176.65 | $218.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.03 / $1,042.24 / $1,758.30
| Facility | | $176.03 | $1,042.24 | $1,758.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.00 / $1,042.24 / $1,309.85
| Facility | | $530.00 | $1,042.24 | $1,309.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.00 / $2,499.00 / $5,235.00
| Facility | | $675.00 | $2,499.00 | $5,235.00 |