- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.00 / $217.00 / $2,525.00
| Facility | | $217.00 | $217.00 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,101.26 / $3,244.31 / $6,762.24
| Facility | | $1,101.26 | $3,244.31 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.16 / $793.10 / $1,907.92
| Facility | | $508.16 | $793.10 | $1,907.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.36 / $723.76 / $1,502.30
| Facility | | $440.36 | $723.76 | $1,502.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.04 / $429.94 / $1,224.00
| Facility | | $229.04 | $429.94 | $1,224.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |