- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.17 / $2,880.44 / $9,062.00
| Facility | | $281.17 | $2,880.44 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.00 / $1,906.22 / $3,536.27
| Facility | | $589.00 | $1,906.22 | $3,536.27 |
- 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
- $281.17 / $1,212.20 / $1,961.84
| Facility | | $281.17 | $1,212.20 | $1,961.84 |
- 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 |