- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.05 / $286.83 / $8,229.00
| Facility | | $134.05 | $286.83 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,316.00 / $4,229.00
| Facility | | $1,258.00 | $2,316.00 | $4,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.30 / $180.22 / $207.90
| Facility | | $131.30 | $180.22 | $207.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.86 / $236.86 / $236.86
| Facility | | $236.86 | $236.86 | $236.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $945.00 / $6,295.00
| Facility | | $575.00 | $945.00 | $6,295.00 |