- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.66 / $787.00 / $8,229.00
| Facility | | $103.66 | $787.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,013.00 / $8,584.00 / $11,253.00
| Facility | | $3,013.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.86 / $139.80 / $161.27
| Facility | | $101.86 | $139.80 | $161.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.52 / $121.52 / $121.52
| Facility | | $121.52 | $121.52 | $121.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $794.00 / $5,301.00
| Facility | | $523.00 | $794.00 | $5,301.00 |