- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.58 / $2,677.64 / $9,062.00
| Facility | | $230.58 | $2,677.64 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.00 / $2,320.92 / $7,305.43
| Facility | | $850.00 | $2,320.92 | $7,305.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $2,221.46
| Facility | | $375.00 | $615.00 | $2,221.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.99 / $1,037.54 / $1,673.46
| Facility | | $225.99 | $1,037.54 | $1,673.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.00 / $12,269.00 / $19,591.00
| Facility | | $870.00 | $12,269.00 | $19,591.00 |