- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.40 / $1,479.15 / $13,335.00
| Facility | | $119.40 | $1,479.15 | $13,335.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,373.28 / $5,135.30 / $9,383.48
| Facility | | $2,373.28 | $5,135.30 | $9,383.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $580.00 / $580.00
| Facility | | $580.00 | $580.00 | $580.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.26 / $179.84 / $264.94
| Facility | | $109.26 | $179.84 | $264.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $1,221.00 / $3,585.00
| Facility | | $225.00 | $1,221.00 | $3,585.00 |