- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.90 / $489.93 / $3,740.00
| Facility | | $172.90 | $489.93 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.00 / $2,315.00 / $4,322.00
| Facility | | $1,066.00 | $2,315.00 | $4,322.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.32 / $220.05 / $253.84
| Facility | | $160.32 | $220.05 | $253.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.20 / $289.20 / $289.20
| Facility | | $289.20 | $289.20 | $289.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $1,339.00 / $5,301.00
| Facility | | $523.00 | $1,339.00 | $5,301.00 |