- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.30 / $518.52 / $7,212.00
| Facility | | $86.30 | $518.52 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.00 / $5,126.00 / $8,240.00
| Facility | | $1,943.00 | $5,126.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.80 / $110.24 / $262.80
| Facility | | $84.80 | $110.24 | $262.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.22 / $949.22 / $1,125.20
| Facility | | $949.22 | $949.22 | $1,125.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,874.00 / $5,490.00
| Facility | | $2,400.00 | $3,874.00 | $5,490.00 |