- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.03 / $3,104.89 / $9,062.00
| Facility | | $395.03 | $3,104.89 | $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 / $5,298.45
| Facility | | $375.00 | $615.00 | $5,298.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.45 / $1,360.33 / $2,040.50
| Facility | | $370.45 | $1,360.33 | $2,040.50 |
- 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 |