- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.40 / $139.90 / $2,168.00
| Facility | | $83.40 | $139.90 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.28 / $1,554.06 / $3,239.20
| Facility | | $417.28 | $1,554.06 | $3,239.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.78 / $484.94 / $1,166.58
| Facility | | $341.78 | $484.94 | $1,166.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.56 / $443.35 / $918.58
| Facility | | $280.56 | $443.35 | $918.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.85 / $200.45 / $417.31
| Facility | | $110.85 | $200.45 | $417.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.00 / $2,872.00 / $4,241.00
| Facility | | $1,187.00 | $2,872.00 | $4,241.00 |