- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.11 / $400.25 / $5,320.00
| Facility | | $155.11 | $400.25 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,316.00 / $4,066.00
| Facility | | $1,258.00 | $2,316.00 | $4,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.83 / $197.41 / $227.73
| Facility | | $143.83 | $197.41 | $227.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.45 / $259.45 / $259.45
| Facility | | $259.45 | $259.45 | $259.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.00 / $100.00 / $3,176.00
| Facility | | $59.00 | $100.00 | $3,176.00 |