- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.06 / $819.01 / $8,229.00
| Facility | | $187.06 | $819.01 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,316.00 / $4,229.00
| Facility | | $1,258.00 | $2,316.00 | $4,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.21 / $250.10 / $288.50
| Facility | | $182.21 | $250.10 | $288.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.70 / $328.70 / $328.70
| Facility | | $328.70 | $328.70 | $328.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $794.00 / $5,301.00
| Facility | | $523.00 | $794.00 | $5,301.00 |