- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.23 / $4,230.00 / $9,727.00
| Facility | | $251.23 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,554.86 / $4,424.99
| Facility | | $1,000.00 | $2,554.86 | $4,424.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.65 / $804.65 / $1,033.99
| Facility | | $804.65 | $804.65 | $1,033.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.55 / $436.65 / $704.06
| Facility | | $213.55 | $436.65 | $704.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.00 / $3,866.00 / $7,558.00
| Facility | | $461.00 | $3,866.00 | $7,558.00 |