- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.82 / $1,354.00 / $11,011.58
| Facility | | $115.82 | $1,354.00 | $11,011.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,498.00 / $8,517.00
| Facility | | $1,643.00 | $3,498.00 | $8,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.11 / $151.13 / $174.34
| Facility | | $110.11 | $151.13 | $174.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.31 / $131.31 / $131.31
| Facility | | $131.31 | $131.31 | $131.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $945.00 / $6,295.00
| Facility | | $575.00 | $945.00 | $6,295.00 |