- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.22 / $203.22 / $2,525.00
| Facility | | $203.22 | $203.22 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.68 / $2,831.53 / $6,031.72
| Facility | | $390.68 | $2,831.53 | $6,031.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.35 / $671.27 / $1,614.84
| Facility | | $473.35 | $671.27 | $1,614.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.80 / $613.70 / $1,271.53
| Facility | | $384.80 | $613.70 | $1,271.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.89 / $392.76 / $4,467.39
| Facility | | $264.89 | $392.76 | $4,467.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |