- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.28 / $3,362.00 / $9,304.00
| Facility | | $676.28 | $3,362.00 | $9,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,214.00 / $10,043.00
| Facility | | $2,088.00 | $4,214.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.63 / $207.63 / $207.63
| Facility | | $207.63 | $207.63 | $207.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.84 / $549.17 / $1,218.94
| Facility | | $132.84 | $549.17 | $1,218.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.00 / $815.00 / $1,300.00
| Facility | | $245.00 | $815.00 | $1,300.00 |