- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.86 / $1,181.00 / $7,439.00
| Facility | | $178.86 | $1,181.00 | $7,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $1,438.74
| Facility | | $530.04 | $530.04 | $1,438.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.86 / $238.52 / $378.80
| Facility | | $178.86 | $238.52 | $378.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.35 / $4,754.80 / $16,394.00
| Facility | | $871.35 | $4,754.80 | $16,394.00 |