- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.40 / $1,050.80 / $11,093.00
| Facility | | $189.40 | $1,050.80 | $11,093.00 |
- 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
- $194.10 / $279.50 / $1,198.88
| Facility | | $194.10 | $279.50 | $1,198.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.40 / $2,218.40 / $2,218.40
| Facility | | $2,218.40 | $2,218.40 | $2,218.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,025.00 / $11,038.00
| Facility | | $3,932.00 | $8,025.00 | $11,038.00 |