- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.25 / $3,213.00 / $7,365.00
| Facility | | $317.25 | $3,213.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $4,852.00
| Facility | | $821.00 | $1,963.00 | $4,852.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.00 / $517.00 / $1,135.71
| Facility | | $517.00 | $517.00 | $1,135.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.90 / $640.85 / $16,394.00
| Facility | | $156.90 | $640.85 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.00 / $2,874.00 / $5,813.00
| Facility | | $1,644.00 | $2,874.00 | $5,813.00 |