- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.52 / $182.52 / $2,525.00
| Facility | | $182.52 | $182.52 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $924.21 / $3,244.31 / $7,034.84
| Facility | | $924.21 | $3,244.31 | $7,034.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.57 / $668.88 / $1,609.09
| Facility | | $428.57 | $668.88 | $1,609.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.39 / $610.40 / $1,267.00
| Facility | | $371.39 | $610.40 | $1,267.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.72 / $364.50 / $1,224.00
| Facility | | $190.72 | $364.50 | $1,224.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.00 / $3,163.00 / $6,275.86
| Facility | | $1,063.00 | $3,163.00 | $6,275.86 |