- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.62 / $2,430.37 / $14,063.00
| Facility | | $228.62 | $2,430.37 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.00 / $6,818.00 / $11,598.00
| Facility | | $2,754.00 | $6,818.00 | $11,598.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.88 / $276.74 / $319.32
| Facility | | $212.88 | $276.74 | $319.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.74 / $761.00 / $1,868.80
| Facility | | $263.74 | $761.00 | $1,868.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $5,995.00 / $9,243.00
| Facility | | $1,500.00 | $5,995.00 | $9,243.00 |