- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.61 / $787.00 / $3,740.00
| Facility | | $170.61 | $787.00 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,584.00 / $10,099.00 / $11,253.00
| Facility | | $8,584.00 | $10,099.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.46 / $252.84 / $298.37
| Facility | | $176.46 | $252.84 | $298.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.17 / $224.17 / $224.17
| Facility | | $224.17 | $224.17 | $224.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $668.00 / $3,176.00
| Facility | | $50.00 | $668.00 | $3,176.00 |