- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $885.20 / $3,131.00 / $7,365.00
| Facility | | $885.20 | $3,131.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $4,852.00
| Facility | | $821.00 | $1,963.00 | $4,852.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $1,135.71
| Facility | | $50.00 | $50.00 | $1,135.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $951.56 / $3,881.00
| Facility | | $55.00 | $951.56 | $3,881.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,694.00 / $2,849.00 / $4,838.00
| Facility | | $1,694.00 | $2,849.00 | $4,838.00 |