- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.80 / $199.80 / $2,525.00
| Facility | | $172.80 | $199.80 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,772.41 / $7,107.25 / $14,098.13
| Facility | | $3,772.41 | $7,107.25 | $14,098.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.89 / $720.24 / $1,732.65
| Facility | | $507.89 | $720.24 | $1,732.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.87 / $658.48 / $1,364.29
| Facility | | $412.87 | $658.48 | $1,364.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.16 / $363.06 / $4,746.00
| Facility | | $249.16 | $363.06 | $4,746.00 |
- 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 |