- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.21 / $4,375.00 / $16,467.00
| Facility | | $490.21 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.75 / $1,198.54 / $2,110.48
| Facility | | $615.75 | $1,198.54 | $2,110.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $375.00 / $1,985.43
| Facility | | $375.00 | $375.00 | $1,985.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.00 / $430.10 / $659.74
| Facility | | $329.00 | $430.10 | $659.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $1,221.00 / $3,585.00
| Facility | | $225.00 | $1,221.00 | $3,585.00 |