- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.62 / $562.94 / $5,320.00
| Facility | | $303.62 | $562.94 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,316.00 / $4,389.00
| Facility | | $1,258.00 | $2,316.00 | $4,389.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.36 / $480.55 / $554.34
| Facility | | $336.36 | $480.55 | $554.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.49 / $631.58 / $631.58
| Facility | | $454.49 | $631.58 | $631.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $2,723.00 / $6,295.00
| Facility | | $599.00 | $2,723.00 | $6,295.00 |