- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.36 / $2,507.00 / $7,194.00
| Facility | | $249.36 | $2,507.00 | $7,194.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,050.00 / $9,663.00
| Facility | | $2,114.00 | $4,050.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.15 / $293.49 / $1,104.18
| Facility | | $161.15 | $293.49 | $1,104.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $2,261.00 / $2,963.00
| Facility | | $1,185.00 | $2,261.00 | $2,963.00 |