- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $9,332.54 / $12,302.69
| Facility | | $154.88 | $9,332.54 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,511.89 / $6,025.60
| Facility | | $2,137.96 | $2,511.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $107.15 / $21,379.62
| Facility | | $77.62 | $107.15 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $9,332.54 / $14,125.38
| Facility | | $4,073.80 | $9,332.54 | $14,125.38 |