- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.27 / $373.00 / $7,212.00
| Facility | | $186.27 | $373.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $5,126.00 / $8,240.00
| Facility | | $2,234.00 | $5,126.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.80 / $236.81 / $436.40
| Facility | | $185.80 | $236.81 | $436.40 |
- 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 |