- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.86 / $3,776.00 / $9,727.00
| Facility | | $111.86 | $3,776.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.17 / $160.36 / $264.11
| Facility | | $87.17 | $160.36 | $264.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $167.33 / $375.00
| Facility | | $100.00 | $167.33 | $375.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.04 / $143.46 / $234.46
| Facility | | $108.04 | $143.46 | $234.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $1,610.00 / $3,585.00
| Facility | | $225.00 | $1,610.00 | $3,585.00 |