- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.54 / $328.71 / $3,740.00
| Facility | | $143.54 | $328.71 | $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
- $144.60 / $198.46 / $228.95
| Facility | | $144.60 | $198.46 | $228.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.83 / $260.83 / $260.83
| Facility | | $260.83 | $260.83 | $260.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.00 / $100.00 / $3,176.00
| Facility | | $59.00 | $100.00 | $3,176.00 |