- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.08 / $3,500.00 / $7,212.00
| Facility | | $186.08 | $3,500.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.00 / $5,117.00 / $8,240.00
| Facility | | $1,943.00 | $5,117.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.90 / $223.47 / $257.85
| Facility | | $171.90 | $223.47 | $257.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.85 / $538.00 / $1,158.10
| Facility | | $214.85 | $538.00 | $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 |