- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.43 / $277.60 / $5,634.00
| Facility | | $100.43 | $277.60 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.00 / $3,840.00 / $7,036.00
| Facility | | $1,636.00 | $3,840.00 | $7,036.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.24 / $121.21 / $318.79
| Facility | | $93.24 | $121.21 | $318.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.38 / $761.00 / $1,158.10
| Facility | | $174.38 | $761.00 | $1,158.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,817.00 / $5,402.00
| Facility | | $900.00 | $3,817.00 | $5,402.00 |