- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.61 / $2,296.35 / $13,335.00
| Facility | | $323.61 | $2,296.35 | $13,335.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,705.00 / $8,385.85
| Facility | | $1,400.00 | $2,705.00 | $8,385.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,106.17 / $2,106.17 / $2,706.47
| Facility | | $2,106.17 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.61 / $1,345.65 / $1,974.75
| Facility | | $323.61 | $1,345.65 | $1,974.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |