- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.95 / $1,786.05 / $13,335.00
| Facility | | $225.95 | $1,786.05 | $13,335.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,363.84 / $2,617.13 / $4,109.81
| Facility | | $1,363.84 | $2,617.13 | $4,109.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,086.58 / $3,086.58 / $3,966.31
| Facility | | $3,086.58 | $3,086.58 | $3,966.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.95 / $1,778.76 / $3,178.00
| Facility | | $225.95 | $1,778.76 | $3,178.00 |
- 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 |