- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.93 / $592.72 / $5,634.00
| Facility | | $142.93 | $592.72 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.00 / $4,320.00 / $8,230.00
| Facility | | $856.00 | $4,320.00 | $8,230.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.24 / $193.86 / $311.57
| Facility | | $141.24 | $193.86 | $311.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.85 / $258.85 / $258.85
| Facility | | $258.85 | $258.85 | $258.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,638.00 / $2,811.00 / $4,271.00
| Facility | | $1,638.00 | $2,811.00 | $4,271.00 |