- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.92 / $947.12 / $5,634.00
| Facility | | $234.92 | $947.12 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.00 / $5,790.87 / $8,240.00
| Facility | | $970.00 | $5,790.87 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.53 / $344.91 / $1,207.98
| Facility | | $239.53 | $344.91 | $1,207.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.40 / $1,286.40 / $1,286.40
| Facility | | $1,286.40 | $1,286.40 | $1,286.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |