- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.06 / $860.00 / $3,740.00
| Facility | | $369.06 | $860.00 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,830.00 / $8,584.00 / $11,253.00
| Facility | | $5,830.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.43 / $572.95 / $660.93
| Facility | | $400.43 | $572.95 | $660.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.04 / $507.04 / $507.04
| Facility | | $507.04 | $507.04 | $507.04 |
- 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 |