- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.61 / $1,898.50 / $7,212.00
| Facility | | $172.61 | $1,898.50 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $5,126.00 / $8,240.00
| Facility | | $2,234.00 | $5,126.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.15 / $182.44 / $430.02
| Facility | | $143.15 | $182.44 | $430.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.59 / $1,061.59 / $1,061.59
| Facility | | $1,061.59 | $1,061.59 | $1,061.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,870.00 / $5,490.00
| Facility | | $2,400.00 | $3,870.00 | $5,490.00 |