- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.70 / $153.94 / $2,525.00
| Facility | | $107.70 | $153.94 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.48 / $3,675.96 / $8,304.51
| Facility | | $482.48 | $3,675.96 | $8,304.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.46 / $510.02 / $1,226.93
| Facility | | $359.46 | $510.02 | $1,226.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.37 / $466.28 / $966.09
| Facility | | $292.37 | $466.28 | $966.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.66 / $199.44 / $431.90
| Facility | | $116.66 | $199.44 | $431.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $2,872.00 / $4,241.00
| Facility | | $1,755.00 | $2,872.00 | $4,241.00 |