- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.94 / $208.87 / $3,740.00
| Facility | | $105.94 | $208.87 | $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
- $104.96 / $143.51 / $165.55
| Facility | | $104.96 | $143.51 | $165.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.05 / $188.62 / $188.62
| Facility | | $125.05 | $188.62 | $188.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $597.00 / $3,176.00
| Facility | | $50.00 | $597.00 | $3,176.00 |