- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.85 / $1,670.55 / $9,062.00
| Facility | | $236.85 | $1,670.55 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.33 / $5,756.96 / $10,184.54
| Facility | | $2,285.33 | $5,756.96 | $10,184.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $2,048.92 / $2,632.90
| Facility | | $505.00 | $2,048.92 | $2,632.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.28 / $308.56 / $473.56
| Facility | | $214.28 | $308.56 | $473.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |