- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.68 / $787.00 / $5,320.00
| Facility | | $145.68 | $787.00 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,257.00 / $4,066.00
| Facility | | $1,258.00 | $2,257.00 | $4,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.16 / $230.10 / $287.63
| Facility | | $157.16 | $230.10 | $287.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.91 / $200.87 / $200.87
| Facility | | $190.91 | $200.87 | $200.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $668.00 / $3,176.00
| Facility | | $50.00 | $668.00 | $3,176.00 |