- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.45 / $907.18 / $2,747.00
| Facility | | $204.45 | $907.18 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,014.00 / $8,584.00 / $11,253.00
| Facility | | $4,014.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.58 / $260.20 / $300.16
| Facility | | $189.58 | $260.20 | $300.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.98 / $341.98 / $341.98
| Facility | | $341.98 | $341.98 | $341.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $3,828.00 / $8,582.00
| Facility | | $739.00 | $3,828.00 | $8,582.00 |