- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.89 / $1,386.00 / $7,212.00
| Facility | | $190.89 | $1,386.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,042.00 / $4,118.00 / $8,240.00
| Facility | | $1,042.00 | $4,118.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.03 / $227.54 / $1,069.82
| Facility | | $175.03 | $227.54 | $1,069.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $4,118.00 / $4,118.00
| Facility | | $761.00 | $4,118.00 | $4,118.00 |
- 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 |