- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.53 / $2,395.19 / $9,062.00
| Facility | | $101.53 | $2,395.19 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.00 / $1,323.03 / $2,391.67
| Facility | | $528.00 | $1,323.03 | $2,391.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $440.00 / $1,139.16
| Facility | | $375.00 | $440.00 | $1,139.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.53 / $348.93 / $1,396.50
| Facility | | $101.53 | $348.93 | $1,396.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.00 / $6,607.00 / $9,900.00
| Facility | | $614.00 | $6,607.00 | $9,900.00 |