- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.66 / $2,598.00 / $7,365.00
| Facility | | $294.66 | $2,598.00 | $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
- $386.00 / $386.00 / $1,135.71
| Facility | | $386.00 | $386.00 | $1,135.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.33 / $579.46 / $12,000.00
| Facility | | $120.33 | $579.46 | $12,000.00 |
- 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 |