- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.92 / $296.38 / $3,740.00
| Facility | | $80.92 | $296.38 | $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
- $78.81 / $108.18 / $124.79
| Facility | | $78.81 | $108.18 | $124.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.01 / $142.18 / $142.18
| Facility | | $128.01 | $142.18 | $142.18 |
- 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 |