- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.08 / $148.08 / $2,525.00
| Facility | | $148.08 | $148.08 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,801.75 / $5,904.89 / $13,308.42
| Facility | | $1,801.75 | $5,904.89 | $13,308.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.17 / $490.91 / $1,180.96
| Facility | | $346.17 | $490.91 | $1,180.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.41 / $448.81 / $929.89
| Facility | | $281.41 | $448.81 | $929.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.78 / $287.61 / $7,729.00
| Facility | | $206.78 | $287.61 | $7,729.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |