- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.37 / $787.00 / $3,740.00
| Facility | | $137.37 | $787.00 | $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
- $149.37 / $212.84 / $245.54
| Facility | | $149.37 | $212.84 | $245.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.37 / $186.37 / $269.45
| Facility | | $186.37 | $186.37 | $269.45 |
- 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 |