- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.70 / $303.35 / $2,042.00
| Facility | | $237.70 | $303.35 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.88 / $2,086.76 / $4,362.78
| Facility | | $1,110.88 | $2,086.76 | $4,362.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.14 / $1,103.66 / $2,655.00
| Facility | | $707.14 | $1,103.66 | $2,655.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.79 / $973.06 / $2,090.55
| Facility | | $612.79 | $973.06 | $2,090.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.82 / $504.71 / $949.60
| Facility | | $270.82 | $504.71 | $949.60 |
- 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 |