- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.50 / $4,344.60 / $7,278.00
| Facility | | $233.50 | $4,344.60 | $7,278.00 |
- 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
- $233.50 / $331.18 / $586.75
| Facility | | $233.50 | $331.18 | $586.75 |
- 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
- $1,302.06 / $4,901.45 / $16,394.00
| Facility | | $1,302.06 | $4,901.45 | $16,394.00 |