- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.80 / $731.00 / $7,212.00
| Facility | | $120.80 | $731.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.00 / $5,230.00 / $8,240.00
| Facility | | $970.00 | $5,230.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.91 / $169.80 / $902.19
| Facility | | $117.91 | $169.80 | $902.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,158.10 / $1,158.10 / $1,158.10
| Facility | | $1,158.10 | $1,158.10 | $1,158.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,462.00 / $3,870.00 / $6,474.00
| Facility | | $2,462.00 | $3,870.00 | $6,474.00 |