- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.71 / $258.82 / $4,846.00
| Facility | | $229.71 | $258.82 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,531.00 / $18,682.34 / $27,646.96
| Facility | | $5,531.00 | $18,682.34 | $27,646.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.88 / $272.83 / $314.82
| Facility | | $209.88 | $272.83 | $314.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.75 / $272.75 / $761.00
| Facility | | $272.75 | $272.75 | $761.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,529.00 / $9,550.00 / $15,750.00
| Facility | | $2,529.00 | $9,550.00 | $15,750.00 |