- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.10 / $131.66 / $5,634.00
| Facility | | $101.10 | $131.66 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.00 / $3,635.00 / $5,445.00
| Facility | | $1,636.00 | $3,635.00 | $5,445.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.12 / $119.76 / $150.78
| Facility | | $92.12 | $119.76 | $150.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.16 / $175.16 / $761.00
| Facility | | $175.16 | $175.16 | $761.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $2,174.00 / $4,426.00
| Facility | | $500.00 | $2,174.00 | $4,426.00 |