- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.37 / $2,344.34 / $5,449.00
| Facility | | $156.37 | $2,344.34 | $5,449.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.44 / $650.35 / $1,226.89
| Facility | | $323.44 | $650.35 | $1,226.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.37 / $452.76 / $3,216.32
| Facility | | $156.37 | $452.76 | $3,216.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,824.00
| Facility | | $393.00 | $650.00 | $4,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,911.31 / $3,911.31
| Facility | | $55.00 | $3,911.31 | $3,911.31 |