- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.59 / $2,450.73 / $9,062.00
| Facility | | $413.59 | $2,450.73 | $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
- $173.15 / $1,023.92 / $1,634.30
| Facility | | $173.15 | $1,023.92 | $1,634.30 |
- 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 |