- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.03 / $3,817.37 / $7,278.00
| Facility | | $187.03 | $3,817.37 | $7,278.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.24 / $842.52 / $1,675.01
| Facility | | $453.24 | $842.52 | $1,675.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.03 / $265.00 / $467.42
| Facility | | $187.03 | $265.00 | $467.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,824.00
| Facility | | $393.00 | $650.00 | $4,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,049.82 / $4,901.45 / $16,394.00
| Facility | | $1,049.82 | $4,901.45 | $16,394.00 |