- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.24 / $326.39 / $2,042.00
| Facility | | $86.24 | $326.39 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.79 / $2,321.25 / $4,787.33
| Facility | | $1,187.79 | $2,321.25 | $4,787.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.12 / $1,177.71 / $2,833.15
| Facility | | $702.12 | $1,177.71 | $2,833.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.60 / $1,038.35 / $2,230.83
| Facility | | $605.60 | $1,038.35 | $2,230.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.45 / $309.73 / $904.71
| Facility | | $125.45 | $309.73 | $904.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.00 / $2,382.32 / $4,195.00
| Facility | | $478.00 | $2,382.32 | $4,195.00 |