- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.77 / $208.77 / $2,525.00
| Facility | | $208.77 | $208.77 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.80 / $3,244.31 / $6,762.24
| Facility | | $1,070.80 | $3,244.31 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.26 / $762.05 / $1,833.21
| Facility | | $488.26 | $762.05 | $1,833.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.12 / $695.42 / $1,443.48
| Facility | | $423.12 | $695.42 | $1,443.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.05 / $413.64 / $2,000.00
| Facility | | $221.05 | $413.64 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.00 / $3,163.00 / $6,275.00
| Facility | | $1,063.00 | $3,163.00 | $6,275.00 |