- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.36 / $75.36 / $2,168.00
| Facility | | $75.36 | $75.36 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,179.53 / $2,063.03 / $3,449.61
| Facility | | $1,179.53 | $2,063.03 | $3,449.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.36 / $261.58 / $629.27
| Facility | | $184.36 | $261.58 | $629.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.60 / $239.15 / $495.49
| Facility | | $167.60 | $239.15 | $495.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.55 / $163.41 / $2,146.62
| Facility | | $84.55 | $163.41 | $2,146.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.00 / $2,872.00 / $4,241.00
| Facility | | $1,187.00 | $2,872.00 | $4,241.00 |