- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.50 / $146.50 / $2,525.00
| Facility | | $146.50 | $146.50 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,283.81 / $3,765.04 / $6,762.24
| Facility | | $2,283.81 | $3,765.04 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.32 / $532.72 / $1,281.53
| Facility | | $341.32 | $532.72 | $1,281.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.79 / $486.14 / $1,009.08
| Facility | | $295.79 | $486.14 | $1,009.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.08 / $287.56 / $603.65
| Facility | | $164.08 | $287.56 | $603.65 |
- 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 |