- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.64 / $787.00 / $3,740.00
| Facility | | $165.64 | $787.00 | $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
- $161.52 / $221.69 / $261.62
| Facility | | $161.52 | $221.69 | $261.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.92 / $291.36 / $291.36
| Facility | | $259.92 | $291.36 | $291.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $597.00 / $3,176.00
| Facility | | $50.00 | $597.00 | $3,176.00 |