- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.32 / $1,095.95 / $9,727.00
| Facility | | $395.32 | $1,095.95 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.00 / $1,649.43 / $2,843.29
| Facility | | $780.00 | $1,649.43 | $2,843.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $2,106.17 / $2,706.47
| Facility | | $375.00 | $2,106.17 | $2,706.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.10 / $574.46 / $1,170.00
| Facility | | $373.10 | $574.46 | $1,170.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.00 / $6,607.00 / $8,667.00
| Facility | | $659.00 | $6,607.00 | $8,667.00 |