- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.95 / $3,246.57 / $9,727.00
| Facility | | $177.95 | $3,246.57 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.94 / $1,005.52 / $1,734.72
| Facility | | $563.94 | $1,005.52 | $1,734.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,007.90 / $1,295.17
| Facility | | $375.00 | $1,007.90 | $1,295.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.95 / $326.45 / $1,854.87
| Facility | | $177.95 | $326.45 | $1,854.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.00 / $6,679.00 / $9,951.00
| Facility | | $1,471.00 | $6,679.00 | $9,951.00 |