- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.23 / $2,215.21 / $4,880.00
| Facility | | $361.23 | $2,215.21 | $4,880.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.41 / $650.35 / $1,226.89
| Facility | | $338.41 | $650.35 | $1,226.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.31 / $330.96 / $497.65
| Facility | | $247.31 | $330.96 | $497.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,824.00
| Facility | | $393.00 | $650.00 | $4,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,712.46 / $1,712.46
| Facility | | $55.00 | $1,712.46 | $1,712.46 |