- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.07 / $3,248.42 / $9,062.00
| Facility | | $311.07 | $3,248.42 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.00 / $2,320.92 / $7,305.43
| Facility | | $850.00 | $2,320.92 | $7,305.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $2,221.46
| Facility | | $375.00 | $615.00 | $2,221.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.86 / $1,362.99 / $2,044.49
| Facility | | $301.86 | $1,362.99 | $2,044.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.00 / $12,269.00 / $19,591.00
| Facility | | $870.00 | $12,269.00 | $19,591.00 |