- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.10 / $1,615.00 / $9,439.39
| Facility | | $739.10 | $1,615.00 | $9,439.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $2,710.28
| Facility | | $395.75 | $395.75 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.10 / $1,007.59 / $1,649.00
| Facility | | $739.10 | $1,007.59 | $1,649.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,759.96 / $8,957.00 / $12,000.00
| Facility | | $2,759.96 | $8,957.00 | $12,000.00 |