- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.05 / $146.01 / $3,740.00
| Facility | | $61.05 | $146.01 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,014.00 / $8,584.00 / $11,253.00
| Facility | | $4,014.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.62 / $77.70 / $91.68
| Facility | | $56.62 | $77.70 | $91.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.12 / $102.12 / $102.12
| Facility | | $102.12 | $102.12 | $102.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.00 / $950.00 / $11,156.00
| Facility | | $391.00 | $950.00 | $11,156.00 |