- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.97 / $2,832.00 / $9,304.00
| Facility | | $120.97 | $2,832.00 | $9,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,214.00 / $10,011.00
| Facility | | $2,088.00 | $4,214.00 | $10,011.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.55 / $61.55 / $61.55
| Facility | | $61.55 | $61.55 | $61.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.84 / $128.13 / $329.06
| Facility | | $36.84 | $128.13 | $329.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.00 / $875.00 / $1,351.00
| Facility | | $245.00 | $875.00 | $1,351.00 |