- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.98 / $4,673.00 / $9,870.00
| Facility | | $267.98 | $4,673.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.05 / $1,871.57 / $3,480.40
| Facility | | $698.05 | $1,871.57 | $3,480.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $1,139.16
| Facility | | $375.00 | $615.00 | $1,139.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.32 / $317.64 / $467.11
| Facility | | $232.32 | $317.64 | $467.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.00 / $4,818.00 / $8,667.00
| Facility | | $614.00 | $4,818.00 | $8,667.00 |