- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.54 / $1,339.76 / $4,311.00
| Facility | | $97.54 | $1,339.76 | $4,311.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.44 / $842.52 / $1,675.01
| Facility | | $323.44 | $842.52 | $1,675.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.08 / $321.61 / $1,054.68
| Facility | | $84.08 | $321.61 | $1,054.68 |
- 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
- $688.10 / $688.10 / $12,000.00
| Facility | | $688.10 | $688.10 | $12,000.00 |