- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.61 / $2,304.42 / $5,634.00
| Facility | | $107.61 | $2,304.42 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,840.00 / $8,240.00
| Facility | | $1,682.00 | $3,840.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.19 / $109.85 / $126.75
| Facility | | $86.19 | $109.85 | $126.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.52 / $847.52 / $847.52
| Facility | | $847.52 | $847.52 | $847.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,638.00 / $2,854.00 / $4,271.00
| Facility | | $1,638.00 | $2,854.00 | $4,271.00 |