- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,137.96 / $4,073.80
| Facility | | $467.74 | $2,137.96 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $147.91 / $602.56
| Facility | | $100.00 | $147.91 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $144.54
| Facility | | $47.86 | $47.86 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $2,951.21 / $2,951.21
| Facility | | $54.95 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $812.83 / $2,511.89
| Facility | | $295.12 | $812.83 | $2,511.89 |