- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.90 / $161.77 / $3,740.00
| Facility | | $80.90 | $161.77 | $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
- $90.45 / $127.32 / $146.87
| Facility | | $90.45 | $127.32 | $146.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.95 / $167.33 / $167.33
| Facility | | $115.95 | $167.33 | $167.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $668.00 / $3,176.00
| Facility | | $50.00 | $668.00 | $3,176.00 |