- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.36 / $226.36 / $2,525.00
| Facility | | $226.36 | $226.36 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,149.34 / $3,310.52 / $6,762.24
| Facility | | $1,149.34 | $3,310.52 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.59 / $826.55 / $1,988.38
| Facility | | $529.59 | $826.55 | $1,988.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.93 / $754.28 / $1,565.65
| Facility | | $458.93 | $754.28 | $1,565.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.82 / $470.80 / $1,652.78
| Facility | | $257.82 | $470.80 | $1,652.78 |
- 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 |