- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.15 / $787.00 / $5,320.00
| Facility | | $189.15 | $787.00 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,257.00 / $4,066.00
| Facility | | $1,258.00 | $2,257.00 | $4,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.87 / $304.27 / $380.35
| Facility | | $209.87 | $304.27 | $380.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.26 / $265.26 / $385.98
| Facility | | $265.26 | $265.26 | $385.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $668.00 / $3,176.00
| Facility | | $50.00 | $668.00 | $3,176.00 |