- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.22 / $2,734.50 / $5,634.00
| Facility | | $152.22 | $2,734.50 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $5,083.00 / $8,240.00
| Facility | | $800.00 | $5,083.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.94 / $183.22 / $211.41
| Facility | | $140.94 | $183.22 | $211.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.03 / $761.00 / $1,158.10
| Facility | | $176.03 | $761.00 | $1,158.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,817.00 / $5,402.00
| Facility | | $900.00 | $3,817.00 | $5,402.00 |