- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.22 / $3,891.51 / $6,915.00
| Facility | | $355.22 | $3,891.51 | $6,915.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.07 / $887.89 / $1,675.01
| Facility | | $258.07 | $887.89 | $1,675.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.01 / $322.81 / $394.48
| Facility | | $224.01 | $322.81 | $394.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,179.00 / $4,877.00
| Facility | | $400.00 | $1,179.00 | $4,877.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,252.56 / $4,901.45
| Facility | | $55.00 | $1,252.56 | $4,901.45 |