- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.44 / $518.58 / $5,634.00
| Facility | | $109.44 | $518.58 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,677.00 / $5,445.00
| Facility | | $1,682.00 | $3,677.00 | $5,445.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.64 / $130.82 / $262.41
| Facility | | $102.64 | $130.82 | $262.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.70 / $279.70 / $279.70
| Facility | | $279.70 | $279.70 | $279.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.00 / $2,252.00 / $4,426.00
| Facility | | $933.00 | $2,252.00 | $4,426.00 |