- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.40 / $158.40 / $2,168.00
| Facility | | $158.40 | $158.40 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.44 / $3,084.88 / $6,762.24
| Facility | | $795.44 | $3,084.88 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.17 / $579.29 / $1,393.59
| Facility | | $371.17 | $579.29 | $1,393.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.64 / $528.65 / $1,097.31
| Facility | | $321.64 | $528.65 | $1,097.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.79 / $320.07 / $1,224.00
| Facility | | $163.79 | $320.07 | $1,224.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,275.86
| Facility | | $1,224.00 | $3,500.00 | $6,275.86 |