- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.52 / $903.00 / $4,505.75
| Facility | | $205.52 | $903.00 | $4,505.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.44 / $650.35 / $1,226.89
| Facility | | $323.44 | $650.35 | $1,226.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.52 / $239.62 / $873.00
| Facility | | $181.52 | $239.62 | $873.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $661.00 / $4,824.00
| Facility | | $393.00 | $661.00 | $4,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.20 / $3,590.15 / $12,000.00
| Facility | | $1,081.20 | $3,590.15 | $12,000.00 |