- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.16 / $218.16 / $2,525.00
| Facility | | $218.16 | $218.16 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.48 / $3,244.31 / $6,762.24
| Facility | | $1,112.48 | $3,244.31 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.69 / $795.49 / $1,913.67
| Facility | | $509.69 | $795.49 | $1,913.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.69 / $725.94 / $1,506.83
| Facility | | $441.69 | $725.94 | $1,506.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.14 / $399.82 / $717.50
| Facility | | $245.14 | $399.82 | $717.50 |
- 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 |