- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.52 / $181.68 / $5,634.00
| Facility | | $131.52 | $181.68 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,840.00 / $7,747.00
| Facility | | $1,682.00 | $3,840.00 | $7,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.21 / $167.23 / $196.99
| Facility | | $131.21 | $167.23 | $196.99 |
- 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 |