- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.04 / $824.00 / $5,634.00
| Facility | | $112.04 | $824.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.87 / $166.87 / $322.06
| Facility | | $166.87 | $166.87 | $322.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.11 / $133.97 / $154.58
| Facility | | $105.11 | $133.97 | $154.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.12 / $134.12 / $761.00
| Facility | | $134.12 | $134.12 | $761.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $3,817.00 / $5,402.00
| Facility | | $725.00 | $3,817.00 | $5,402.00 |