- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.83 / $3,457.85 / $4,376.00
| Facility | | $262.83 | $3,457.85 | $4,376.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.38 / $887.89 / $1,675.01
| Facility | | $282.38 | $887.89 | $1,675.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.10 / $354.73 / $495.95
| Facility | | $164.10 | $354.73 | $495.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,824.00
| Facility | | $393.00 | $650.00 | $4,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,134.42 / $1,134.42
| Facility | | $55.00 | $1,134.42 | $1,134.42 |