- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.50 / $2,817.00 / $5,634.00
| Facility | | $120.50 | $2,817.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.00 / $3,840.00 / $7,036.00
| Facility | | $1,636.00 | $3,840.00 | $7,036.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.57 / $145.04 / $167.36
| Facility | | $111.57 | $145.04 | $167.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.34 / $655.97 / $761.00
| Facility | | $139.34 | $655.97 | $761.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,817.00 / $5,402.00
| Facility | | $900.00 | $3,817.00 | $5,402.00 |