- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.08 / $105.08 / $2,168.00
| Facility | | $105.08 | $105.08 | $2,168.00 |
- 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
- $246.43 / $384.61 / $925.23
| Facility | | $246.43 | $384.61 | $925.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.55 / $350.98 / $728.53
| Facility | | $213.55 | $350.98 | $728.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.82 / $208.74 / $396.19
| Facility | | $118.82 | $208.74 | $396.19 |
- 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 |