- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.28 / $3,324.49 / $5,177.00
| Facility | | $123.28 | $3,324.49 | $5,177.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $4,252.29
| Facility | | $395.75 | $395.75 | $4,252.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.28 / $238.08 / $608.89
| Facility | | $123.28 | $238.08 | $608.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,618.66 / $8,541.00 / $13,997.00
| Facility | | $2,618.66 | $8,541.00 | $13,997.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,577.04 / $1,577.04 / $12,000.00
| Facility | | $1,577.04 | $1,577.04 | $12,000.00 |