- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.41 / $237.41 / $2,525.00
| Facility | | $237.41 | $237.41 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.40 / $2,635.43 / $5,691.54
| Facility | | $849.40 | $2,635.43 | $5,691.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.73 / $744.13 / $1,790.11
| Facility | | $524.73 | $744.13 | $1,790.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.57 / $680.32 / $1,409.54
| Facility | | $426.57 | $680.32 | $1,409.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.88 / $485.11 / $4,024.32
| Facility | | $373.88 | $485.11 | $4,024.32 |
- 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 |