- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.31 / $4,376.00 / $6,519.00
| Facility | | $213.31 | $4,376.00 | $6,519.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.81 / $1,927.35 / $3,635.94
| Facility | | $209.81 | $1,927.35 | $3,635.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.77 / $248.86 / $315.45
| Facility | | $179.77 | $248.86 | $315.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,824.00
| Facility | | $393.00 | $650.00 | $4,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,201.27 / $10,639.60
| Facility | | $55.00 | $1,201.27 | $10,639.60 |