- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.40 / $196.40 / $2,168.00
| Facility | | $196.40 | $196.40 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $904.09 / $2,796.20 / $5,711.66
| Facility | | $904.09 | $2,796.20 | $5,711.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.16 / $678.44 / $1,632.08
| Facility | | $478.16 | $678.44 | $1,632.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.69 / $620.26 / $1,285.09
| Facility | | $434.69 | $620.26 | $1,285.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.94 / $337.05 / $2,794.39
| Facility | | $202.94 | $337.05 | $2,794.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |