- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.24 / $2,563.60 / $9,062.00
| Facility | | $176.24 | $2,563.60 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,483.92 / $4,694.54 / $7,666.70
| Facility | | $2,483.92 | $4,694.54 | $7,666.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $1,677.54
| Facility | | $505.00 | $505.00 | $1,677.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.27 / $264.00 / $422.06
| Facility | | $141.27 | $264.00 | $422.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $10,257.00 / $16,249.00
| Facility | | $1,258.00 | $10,257.00 | $16,249.00 |