- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.11 / $947.88 / $5,634.00
| Facility | | $201.11 | $947.88 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.00 / $5,757.57 / $8,388.00
| Facility | | $1,153.00 | $5,757.57 | $8,388.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.21 / $296.94 / $1,224.60
| Facility | | $206.21 | $296.94 | $1,224.60 |
- 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 |