- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $575.44 / $3,890.45
| Facility | | $89.13 | $575.44 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,137.96 / $2,951.21
| Facility | | $1,348.96 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $70.79 / $100.00
| Facility | | $57.54 | $70.79 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $1,318.26
| Facility | | $112.20 | $112.20 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $794.33 / $3,388.44
| Facility | | $331.13 | $794.33 | $3,388.44 |