- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.56 / $860.00 / $8,229.00
| Facility | | $162.56 | $860.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.00 / $2,067.00 / $2,978.00
| Facility | | $1,041.00 | $2,067.00 | $2,978.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.94 / $219.52 / $253.23
| Facility | | $159.94 | $219.52 | $253.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.68 / $192.68 / $192.68
| Facility | | $192.68 | $192.68 | $192.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $794.00 / $5,301.00
| Facility | | $523.00 | $794.00 | $5,301.00 |