- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.55 / $787.00 / $3,740.00
| Facility | | $119.55 | $787.00 | $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
- $126.76 / $184.72 / $213.09
| Facility | | $126.76 | $184.72 | $213.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.52 / $161.52 / $161.52
| Facility | | $161.52 | $161.52 | $161.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $668.00 / $3,176.00
| Facility | | $50.00 | $668.00 | $3,176.00 |