- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.61 / $1,798.85 / $9,062.00
| Facility | | $180.61 | $1,798.85 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.00 / $5,628.92 / $10,416.10
| Facility | | $561.00 | $5,628.92 | $10,416.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $5,602.24
| Facility | | $375.00 | $615.00 | $5,602.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.52 / $229.43 / $307.04
| Facility | | $153.52 | $229.43 | $307.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.00 / $6,172.00 / $8,667.00
| Facility | | $586.00 | $6,172.00 | $8,667.00 |