- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.25 / $3,213.00 / $7,985.60
| Facility | | $369.25 | $3,213.00 | $7,985.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.00 / $1,963.00 / $5,295.00
| Facility | | $902.00 | $1,963.00 | $5,295.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,231.00 / $9,308.00 / $10,577.00
| Facility | | $6,231.00 | $9,308.00 | $10,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.78 / $174.57 / $531.37
| Facility | | $107.78 | $174.57 | $531.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.00 / $760.00 / $1,351.00
| Facility | | $247.00 | $760.00 | $1,351.00 |