- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.27 / $443.52 / $3,740.00
| Facility | | $201.27 | $443.52 | $3,740.00 |
- 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
- $200.94 / $275.80 / $318.16
| Facility | | $200.94 | $275.80 | $318.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.97 / $362.48 / $362.48
| Facility | | $216.97 | $362.48 | $362.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $2,723.00 / $6,295.00
| Facility | | $599.00 | $2,723.00 | $6,295.00 |