- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.21 / $4,450.00 / $8,031.00
| Facility | | $194.21 | $4,450.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $5,786.00 / $10,432.00
| Facility | | $2,807.00 | $5,786.00 | $10,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.97 / $326.43 / $767.00
| Facility | | $204.97 | $326.43 | $767.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.16 / $809.30 / $1,060.24
| Facility | | $556.16 | $809.30 | $1,060.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.00 / $3,075.00 / $6,664.00
| Facility | | $357.00 | $3,075.00 | $6,664.00 |