- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.13 / $1,386.00 / $7,212.00
| Facility | | $119.13 | $1,386.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $879.62 / $5,665.00 / $8,388.00
| Facility | | $879.62 | $5,665.00 | $8,388.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.44 / $121.06 / $135.59
| Facility | | $86.44 | $121.06 | $135.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.30 / $1,178.83 / $1,178.83
| Facility | | $119.30 | $1,178.83 | $1,178.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,817.00 / $5,490.00
| Facility | | $1,000.00 | $3,817.00 | $5,490.00 |