- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $1,520.00 / $3,685.00
| Facility | | $443.91 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,171.08 / $1,947.29 / $3,606.87
| Facility | | $1,171.08 | $1,947.29 | $3,606.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.92 / $1,374.83 / $1,374.83
| Facility | | $103.92 | $1,374.83 | $1,374.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.49 / $525.00 / $1,197.32
| Facility | | $199.49 | $525.00 | $1,197.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,010.00
| Facility | | $470.00 | $1,429.00 | $4,010.00 |