- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.24 / $1,245.00 / $7,278.00
| Facility | | $177.24 | $1,245.00 | $7,278.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.22 / $1,050.74 / $1,783.07
| Facility | | $955.22 | $1,050.74 | $1,783.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.24 / $842.52 / $1,675.01
| Facility | | $453.24 | $842.52 | $1,675.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.24 / $251.02 / $426.21
| Facility | | $177.24 | $251.02 | $426.21 |
- 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
- $991.44 / $4,901.45 / $16,394.00
| Facility | | $991.44 | $4,901.45 | $16,394.00 |