- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.21 / $1,716.00 / $8,229.00
| Facility | | $153.21 | $1,716.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.00 / $2,067.00 / $2,978.00
| Facility | | $1,041.00 | $2,067.00 | $2,978.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.26 / $204.86 / $236.32
| Facility | | $149.26 | $204.86 | $236.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.25 / $269.25 / $269.25
| Facility | | $269.25 | $269.25 | $269.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $794.00 / $5,301.00
| Facility | | $523.00 | $794.00 | $5,301.00 |