- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.20 / $388.20 / $6,575.00
| Facility | | $388.20 | $388.20 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.30 / $3,542.66 / $7,138.18
| Facility | | $1,763.30 | $3,542.66 | $7,138.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $962.21 / $1,365.24 / $3,284.27
| Facility | | $962.21 | $1,365.24 | $3,284.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.74 / $1,248.16 / $2,586.04
| Facility | | $874.74 | $1,248.16 | $2,586.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.20 / $746.92 / $4,708.43
| Facility | | $388.20 | $746.92 | $4,708.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $3,756.00 / $8,193.00
| Facility | | $2,412.00 | $3,756.00 | $8,193.00 |