- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.59 / $222.59 / $6,575.00
| Facility | | $222.59 | $222.59 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.17 / $5,064.68 / $11,441.84
| Facility | | $2,243.17 | $5,064.68 | $11,441.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.76 / $820.58 / $1,974.01
| Facility | | $525.76 | $820.58 | $1,974.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.62 / $748.83 / $1,554.34
| Facility | | $455.62 | $748.83 | $1,554.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.62 / $413.33 / $2,291.21
| Facility | | $228.62 | $413.33 | $2,291.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.00 / $4,746.00 / $8,812.00
| Facility | | $1,623.00 | $4,746.00 | $8,812.00 |