- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.43 / $1,654.00 / $9,311.00
| Facility | | $220.43 | $1,654.00 | $9,311.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,174.00 / $4,508.00 / $9,461.00
| Facility | | $2,174.00 | $4,508.00 | $9,461.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.02 / $297.88 / $343.62
| Facility | | $217.02 | $297.88 | $343.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.74 / $263.74 / $263.74
| Facility | | $263.74 | $263.74 | $263.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $945.00 / $6,295.00
| Facility | | $575.00 | $945.00 | $6,295.00 |