- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.62 / $1,386.00 / $5,634.00
| Facility | | $88.62 | $1,386.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,677.00 / $5,445.00
| Facility | | $1,682.00 | $3,677.00 | $5,445.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.53 / $127.55 / $191.33
| Facility | | $93.53 | $127.55 | $191.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.05 / $506.05 / $506.05
| Facility | | $506.05 | $506.05 | $506.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,638.00 / $2,854.00 / $4,271.00
| Facility | | $1,638.00 | $2,854.00 | $4,271.00 |