- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.85 / $4,230.00 / $9,727.00
| Facility | | $157.85 | $4,230.00 | $9,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.88 / $357.68 / $595.57
| Facility | | $179.88 | $357.68 | $595.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.57 / $174.57 / $505.00
| Facility | | $174.57 | $174.57 | $505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.21 / $251.41 / $391.96
| Facility | | $143.21 | $251.41 | $391.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $1,221.00 / $3,585.00
| Facility | | $225.00 | $1,221.00 | $3,585.00 |