- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.51 / $960.51 / $9,727.00
| Facility | | $219.51 | $960.51 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,502.93 / $4,499.91 / $7,538.20
| Facility | | $1,502.93 | $4,499.91 | $7,538.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $1,221.33 / $1,569.43
| Facility | | $505.00 | $1,221.33 | $1,569.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.51 / $441.69 / $738.48
| Facility | | $219.51 | $441.69 | $738.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.00 / $6,607.00 / $8,667.00
| Facility | | $659.00 | $6,607.00 | $8,667.00 |