- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.03 / $3,445.00 / $10,268.00
| Facility | | $346.03 | $3,445.00 | $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
- $183.42 / $220.10 / $272.42
| Facility | | $183.42 | $220.10 | $272.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.88 / $1,042.24 / $1,758.30
| Facility | | $218.88 | $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 / $2,665.00 / $5,457.00
| Facility | | $675.00 | $2,665.00 | $5,457.00 |