- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.73 / $3,253.60 / $4,922.05
| Facility | | $104.73 | $3,253.60 | $4,922.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.30 / $606.10 / $1,704.99
| Facility | | $119.30 | $606.10 | $1,704.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.73 / $121.06 / $178.04
| Facility | | $104.73 | $121.06 | $178.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $3,235.00 / $5,358.00
| Facility | | $400.00 | $3,235.00 | $5,358.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $244.35 / $4,989.20
| Facility | | $55.00 | $244.35 | $4,989.20 |