- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.45 / $5,866.00 / $16,467.00
| Facility | | $167.45 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,175.92 / $4,657.84 / $7,666.70
| Facility | | $2,175.92 | $4,657.84 | $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
- $136.02 / $196.16 / $289.00
| Facility | | $136.02 | $196.16 | $289.00 |
- 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 |