- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.83 / $272.68 / $2,042.00
| Facility | | $96.83 | $272.68 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,533.65 / $2,631.94 / $5,194.88
| Facility | | $1,533.65 | $2,631.94 | $5,194.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.75 / $992.58 / $2,387.77
| Facility | | $591.75 | $992.58 | $2,387.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.40 / $875.13 / $1,880.14
| Facility | | $510.40 | $875.13 | $1,880.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.57 / $304.82 / $795.18
| Facility | | $131.57 | $304.82 | $795.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |