- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.93 / $860.00 / $8,229.00
| Facility | | $177.93 | $860.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,830.00 / $8,584.00 / $11,253.00
| Facility | | $5,830.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.77 / $239.88 / $276.72
| Facility | | $174.77 | $239.88 | $276.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.81 / $209.81 / $209.81
| Facility | | $209.81 | $209.81 | $209.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $794.00 / $5,301.00
| Facility | | $523.00 | $794.00 | $5,301.00 |