- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.35 / $1,386.00 / $11,093.00
| Facility | | $225.35 | $1,386.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,573.00 / $6,474.00 / $13,758.00
| Facility | | $2,573.00 | $6,474.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.29 / $270.77 / $312.44
| Facility | | $208.29 | $270.77 | $312.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.33 / $761.00 / $3,191.07
| Facility | | $263.33 | $761.00 | $3,191.07 |
- 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 |