- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.26 / $988.00 / $3,740.00
| Facility | | $196.26 | $988.00 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.00 / $2,067.00 / $2,978.00
| Facility | | $1,041.00 | $2,067.00 | $2,978.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.43 / $254.21 / $293.25
| Facility | | $177.43 | $254.21 | $293.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.94 / $223.94 / $267.14
| Facility | | $223.94 | $223.94 | $267.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $1,450.00 / $5,301.00
| Facility | | $523.00 | $1,450.00 | $5,301.00 |