- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.85 / $132.85 / $2,525.00
| Facility | | $132.85 | $132.85 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.37 / $3,084.88 / $6,762.24
| Facility | | $287.37 | $3,084.88 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.24 / $487.33 / $1,172.33
| Facility | | $312.24 | $487.33 | $1,172.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.58 / $444.72 / $923.10
| Facility | | $270.58 | $444.72 | $923.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.38 / $244.39 / $1,224.00
| Facility | | $144.38 | $244.39 | $1,224.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,275.86
| Facility | | $1,224.00 | $3,500.00 | $6,275.86 |