- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.49 / $1,386.00 / $5,634.00
| Facility | | $166.49 | $1,386.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $5,757.57 / $8,240.00
| Facility | | $800.00 | $5,757.57 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.78 / $199.91 / $230.67
| Facility | | $153.78 | $199.91 | $230.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.61 / $761.00 / $1,158.10
| Facility | | $192.61 | $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 |