- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.94 / $288.62 / $2,042.00
| Facility | | $148.94 | $288.62 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.43 / $222.25 / $453.98
| Facility | | $124.43 | $222.25 | $453.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.92 / $1,049.91 / $2,525.69
| Facility | | $625.92 | $1,049.91 | $2,525.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.60 / $925.67 / $1,988.74
| Facility | | $540.60 | $925.67 | $1,988.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.13 / $329.57 / $806.30
| Facility | | $139.13 | $329.57 | $806.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.00 / $1,727.00 / $2,883.00
| Facility | | $133.00 | $1,727.00 | $2,883.00 |