- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.57 / $114.57 / $2,168.00
| Facility | | $114.57 | $114.57 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.79 / $2,851.36 / $5,031.89
| Facility | | $1,187.79 | $2,851.36 | $5,031.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.14 / $421.64 / $1,014.30
| Facility | | $270.14 | $421.64 | $1,014.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.11 / $384.77 / $798.66
| Facility | | $234.11 | $384.77 | $798.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.56 / $231.50 / $1,224.00
| Facility | | $128.56 | $231.50 | $1,224.00 |
- 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 |