- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.20 / $734.95 / $5,320.00
| Facility | | $292.20 | $734.95 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,316.00 / $4,229.00
| Facility | | $1,258.00 | $2,316.00 | $4,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.06 / $455.80 / $525.79
| Facility | | $320.06 | $455.80 | $525.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.35 / $404.35 / $723.68
| Facility | | $404.35 | $404.35 | $723.68 |
- 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 |