- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.81 / $3,232.00 / $9,133.00
| Facility | | $452.81 | $3,232.00 | $9,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.00 / $1,450.76 / $2,599.91
| Facility | | $1,036.00 | $1,450.76 | $2,599.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.00 / $1,260.00 / $1,260.00
| Facility | | $914.00 | $1,260.00 | $1,260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.26 / $412.59 / $803.87
| Facility | | $252.26 | $412.59 | $803.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $2,440.66 / $3,842.00
| Facility | | $825.00 | $2,440.66 | $3,842.00 |