- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.32 / $254.72 / $3,740.00
| Facility | | $91.32 | $254.72 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,013.00 / $8,584.00 / $11,253.00
| Facility | | $3,013.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.82 / $109.37 / $127.69
| Facility | | $89.82 | $109.37 | $127.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.03 / $162.03 / $279.73
| Facility | | $162.03 | $162.03 | $279.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $597.00 / $1,895.00
| Facility | | $50.00 | $597.00 | $1,895.00 |