- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.11 / $787.00 / $3,740.00
| Facility | | $265.11 | $787.00 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.00 / $1,991.00 / $2,894.00
| Facility | | $1,041.00 | $1,991.00 | $2,894.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.08 / $426.34 / $532.92
| Facility | | $294.08 | $426.34 | $532.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.07 / $375.07 / $510.63
| Facility | | $375.07 | $375.07 | $510.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $668.00 / $3,176.00
| Facility | | $50.00 | $668.00 | $3,176.00 |