- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.55 / $275.81 / $2,525.00
| Facility | | $75.55 | $275.81 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.94 / $1,024.70 / $2,232.51
| Facility | | $153.94 | $1,024.70 | $2,232.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.22 / $899.41 / $2,163.65
| Facility | | $634.22 | $899.41 | $2,163.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.58 / $822.28 / $1,703.66
| Facility | | $515.58 | $822.28 | $1,703.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.95 / $393.02 / $2,034.00
| Facility | | $123.95 | $393.02 | $2,034.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $2,872.00 / $4,241.00
| Facility | | $1,755.00 | $2,872.00 | $4,241.00 |