- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.16 / $1,475.76 / $6,717.22
| Facility | | $157.16 | $1,475.76 | $6,717.22 |
- 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
- $139.94 / $200.03 / $230.76
| Facility | | $139.94 | $200.03 | $230.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.43 / $177.43 / $217.99
| Facility | | $177.43 | $177.43 | $217.99 |
- 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 |