- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.37 / $1,941.00 / $7,212.00
| Facility | | $157.37 | $1,941.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,266.00 / $5,570.00 / $13,810.27
| Facility | | $2,266.00 | $5,570.00 | $13,810.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.21 / $188.89 / $217.95
| Facility | | $148.21 | $188.89 | $217.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,158.09 / $2,158.09 / $2,158.09
| Facility | | $2,158.09 | $2,158.09 | $2,158.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |