- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.78 / $809.44 / $5,634.00
| Facility | | $211.78 | $809.44 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.00 / $5,790.87 / $8,240.00
| Facility | | $1,153.00 | $5,790.87 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.07 / $311.66 / $1,036.04
| Facility | | $224.07 | $311.66 | $1,036.04 |
- 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 |