- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.58 / $543.00 / $5,634.00
| Facility | | $208.58 | $543.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,950.00 / $13,810.27
| Facility | | $1,682.00 | $3,950.00 | $13,810.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.37 / $252.82 / $343.80
| Facility | | $198.37 | $252.82 | $343.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.75 / $1,610.75 / $1,610.75
| Facility | | $1,610.75 | $1,610.75 | $1,610.75 |
- 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 |