- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.09 / $2,171.40 / $9,062.00
| Facility | | $499.09 | $2,171.40 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,730.42 / $7,168.58 / $12,337.09
| Facility | | $2,730.42 | $7,168.58 | $12,337.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $2,106.17 / $2,706.47
| Facility | | $375.00 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.26 / $547.26 / $901.36
| Facility | | $399.26 | $547.26 | $901.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |