- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.64 / $175.70 / $3,740.00
| Facility | | $125.64 | $175.70 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,584.00 / $10,099.00 / $11,253.00
| Facility | | $8,584.00 | $10,099.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.62 / $186.16 / $214.74
| Facility | | $135.62 | $186.16 | $214.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.66 / $244.66 / $244.66
| Facility | | $244.66 | $244.66 | $244.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $597.00 / $3,176.00
| Facility | | $50.00 | $597.00 | $3,176.00 |