- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.80 / $1,211.46 / $9,062.00
| Facility | | $398.80 | $1,211.46 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.00 / $1,925.57 / $3,825.20
| Facility | | $792.00 | $1,925.57 | $3,825.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $570.00 / $1,139.16
| Facility | | $375.00 | $570.00 | $1,139.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.88 / $203.59 / $352.47
| Facility | | $148.88 | $203.59 | $352.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.00 / $6,607.00 / $9,900.00
| Facility | | $614.00 | $6,607.00 | $9,900.00 |