- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.86 / $1,006.56 / $3,400.00
| Facility | | $186.86 | $1,006.56 | $3,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,494.80 / $1,644.27 / $2,790.28
| Facility | | $1,494.80 | $1,644.27 | $2,790.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.99 / $495.36 / $812.00
| Facility | | $133.99 | $495.36 | $812.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.72 / $163.52 / $227.16
| Facility | | $116.72 | $163.52 | $227.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.00 / $120.00 / $1,251.00
| Facility | | $54.00 | $120.00 | $1,251.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $299.77 / $570.71
| Facility | | $55.00 | $299.77 | $570.71 |