- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.18 / $2,475.00 / $10,268.00
| Facility | | $249.18 | $2,475.00 | $10,268.00 |
- 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
- $160.19 / $192.23 / $237.93
| Facility | | $160.19 | $192.23 | $237.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.61 / $1,042.24 / $1,758.30
| Facility | | $192.61 | $1,042.24 | $1,758.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.00 / $1,042.24 / $1,758.30
| Facility | | $530.00 | $1,042.24 | $1,758.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.00 / $2,551.00 / $5,235.00
| Facility | | $707.00 | $2,551.00 | $5,235.00 |