- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.50 / $3,023.44 / $9,062.00
| Facility | | $305.50 | $3,023.44 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.00 / $1,323.03 / $2,391.67
| Facility | | $735.00 | $1,323.03 | $2,391.67 |
- 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
- $296.57 / $1,442.50 / $2,163.73
| Facility | | $296.57 | $1,442.50 | $2,163.73 |
- 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 |