- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.74 / $4,230.00 / $9,727.00
| Facility | | $126.74 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,153.02 / $4,069.15 / $6,619.00
| Facility | | $2,153.02 | $4,069.15 | $6,619.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $1,677.54
| Facility | | $505.00 | $505.00 | $1,677.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.36 / $152.00 / $239.10
| Facility | | $102.36 | $152.00 | $239.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.00 / $3,866.00 / $6,584.00
| Facility | | $461.00 | $3,866.00 | $6,584.00 |