- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.52 / $1,210.42 / $5,449.00
| Facility | | $151.52 | $1,210.42 | $5,449.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.30 / $515.00 / $606.10
| Facility | | $263.30 | $515.00 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.52 / $844.23 / $1,207.25
| Facility | | $151.52 | $844.23 | $1,207.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.00 / $120.00 / $1,251.00
| Facility | | $54.00 | $120.00 | $1,251.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,464.80 / $1,464.80
| Facility | | $55.00 | $1,464.80 | $1,464.80 |