- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.75 / $311.14 / $7,212.00
| Facility | | $107.75 | $311.14 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.00 / $4,353.00 / $8,052.00
| Facility | | $1,804.00 | $4,353.00 | $8,052.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.23 / $153.27 / $241.15
| Facility | | $105.23 | $153.27 | $241.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.32 / $287.32 / $287.32
| Facility | | $287.32 | $287.32 | $287.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.00 / $2,252.00 / $4,426.00
| Facility | | $933.00 | $2,252.00 | $4,426.00 |