- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.05 / $543.00 / $5,634.00
| Facility | | $141.05 | $543.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,042.00 / $4,097.10 / $8,230.00
| Facility | | $1,042.00 | $4,097.10 | $8,230.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.19 / $199.85 / $421.38
| Facility | | $137.19 | $199.85 | $421.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.38 / $310.38 / $310.38
| Facility | | $310.38 | $310.38 | $310.38 |
- 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 |