- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.58 / $1,083.06 / $5,449.00
| Facility | | $47.58 | $1,083.06 | $5,449.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.44 / $585.73 / $975.74
| Facility | | $323.44 | $585.73 | $975.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.58 / $736.96 / $1,218.54
| Facility | | $47.58 | $736.96 | $1,218.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,824.00
| Facility | | $393.00 | $650.00 | $4,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,151.97 / $1,151.97
| Facility | | $55.00 | $1,151.97 | $1,151.97 |