- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.41 / $1,386.00 / $5,634.00
| Facility | | $137.41 | $1,386.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.00 / $3,840.00 / $7,036.00
| Facility | | $1,636.00 | $3,840.00 | $7,036.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.56 / $164.53 / $189.84
| Facility | | $126.56 | $164.53 | $189.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.47 / $761.00 / $1,158.10
| Facility | | $158.47 | $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 |