- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.07 / $186.07 / $186.07
| Facility | | $186.07 | $186.07 | $186.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,455.14 / $1,972.09 / $3,702.11
| Facility | | $1,455.14 | $1,972.09 | $3,702.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.83 / $359.49 / $4,317.00
| Facility | | $197.83 | $359.49 | $4,317.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.77 / $447.59 / $651.78
| Facility | | $371.77 | $447.59 | $651.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |