- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.56 / $703.10 / $7,212.00
| Facility | | $170.56 | $703.10 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $5,126.00 / $8,240.00
| Facility | | $2,234.00 | $5,126.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.58 / $204.66 / $361.88
| Facility | | $160.58 | $204.66 | $361.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.59 / $1,061.59 / $1,061.59
| Facility | | $1,061.59 | $1,061.59 | $1,061.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,870.00 / $5,490.00
| Facility | | $2,400.00 | $3,870.00 | $5,490.00 |