- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.15 / $290.92 / $2,042.00
| Facility | | $62.15 | $290.92 | $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
- $626.64 / $1,051.09 / $2,528.57
| Facility | | $626.64 | $1,051.09 | $2,528.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.50 / $926.73 / $1,991.00
| Facility | | $540.50 | $926.73 | $1,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.33 / $257.33 / $842.05
| Facility | | $87.33 | $257.33 | $842.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.00 / $2,872.00 / $4,241.00
| Facility | | $478.00 | $2,872.00 | $4,241.00 |