- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.17 / $725.88 / $3,740.00
| Facility | | $121.17 | $725.88 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,584.00 / $10,099.00 / $11,253.00
| Facility | | $8,584.00 | $10,099.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.70 / $161.55 / $190.64
| Facility | | $117.70 | $161.55 | $190.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.30 / $212.32 / $212.32
| Facility | | $175.30 | $212.32 | $212.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $597.00 / $3,176.00
| Facility | | $50.00 | $597.00 | $3,176.00 |