- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.80 / $188.80 / $2,525.00
| Facility | | $188.80 | $188.80 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.20 / $3,194.17 / $6,762.24
| Facility | | $960.20 | $3,194.17 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.34 / $690.38 / $1,660.81
| Facility | | $442.34 | $690.38 | $1,660.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.33 / $630.02 / $1,307.73
| Facility | | $383.33 | $630.02 | $1,307.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.68 / $346.39 / $824.00
| Facility | | $205.68 | $346.39 | $824.00 |
- 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 |