- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.91 / $373.91 / $2,525.00
| Facility | | $373.91 | $373.91 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.74 / $4,844.72 / $10,098.06
| Facility | | $704.74 | $4,844.72 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.23 / $1,297.16 / $3,120.49
| Facility | | $914.23 | $1,297.16 | $3,120.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.12 / $1,185.91 / $2,457.08
| Facility | | $831.12 | $1,185.91 | $2,457.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.84 / $647.67 / $2,735.00
| Facility | | $390.84 | $647.67 | $2,735.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |