- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.29 / $2,955.30 / $11,124.29
| Facility | | $193.29 | $2,955.30 | $11,124.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $5,757.57 / $8,240.00
| Facility | | $800.00 | $5,757.57 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.71 / $231.02 / $266.57
| Facility | | $177.71 | $231.02 | $266.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.47 / $761.00 / $1,873.52
| Facility | | $222.47 | $761.00 | $1,873.52 |
- 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 |