- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.70 / $2,318.00 / $16,042.00
| Facility | | $267.70 | $2,318.00 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,278.00 / $7,581.00 / $14,620.00
| Facility | | $3,278.00 | $7,581.00 | $14,620.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.23 / $318.92 / $367.98
| Facility | | $250.23 | $318.92 | $367.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.79 / $2,243.79 / $2,243.79
| Facility | | $2,243.79 | $2,243.79 | $2,243.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |