- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.06 / $787.00 / $3,740.00
| Facility | | $118.06 | $787.00 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.21 / $1,036.13 / $11,253.00
| Facility | | $343.21 | $1,036.13 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.85 / $184.18 / $212.48
| Facility | | $122.85 | $184.18 | $212.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.96 / $159.96 / $171.10
| Facility | | $159.96 | $159.96 | $171.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $668.00 / $3,176.00
| Facility | | $50.00 | $668.00 | $3,176.00 |