- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.89 / $207.60 / $2,747.00
| Facility | | $110.89 | $207.60 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,346.00 / $8,517.00
| Facility | | $1,643.00 | $3,346.00 | $8,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.33 / $148.96 / $173.90
| Facility | | $122.33 | $148.96 | $173.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.56 / $220.67 / $220.67
| Facility | | $142.56 | $220.67 | $220.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $597.00 / $1,895.00
| Facility | | $50.00 | $597.00 | $1,895.00 |