- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.29 / $4,375.00 / $16,467.00
| Facility | | $532.29 | $4,375.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.17 / $1,212.96 / $2,292.52
| Facility | | $645.17 | $1,212.96 | $2,292.52 |
- 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
- $353.00 / $457.80 / $718.61
| Facility | | $353.00 | $457.80 | $718.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.00 / $6,607.00 / $8,667.00
| Facility | | $659.00 | $6,607.00 | $8,667.00 |