- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.69 / $311.69 / $2,525.00
| Facility | | $311.69 | $311.69 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.50 / $6,024.48 / $13,610.15
| Facility | | $814.50 | $6,024.48 | $13,610.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.33 / $1,138.30 / $2,738.33
| Facility | | $729.33 | $1,138.30 | $2,738.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.03 / $1,038.77 / $2,156.16
| Facility | | $632.03 | $1,038.77 | $2,156.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.34 / $617.40 / $1,623.00
| Facility | | $340.34 | $617.40 | $1,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.00 / $4,746.00 / $8,812.00
| Facility | | $1,623.00 | $4,746.00 | $8,812.00 |