- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.62 / $221.62 / $2,525.00
| Facility | | $221.62 | $221.62 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,125.31 / $3,244.31 / $6,762.24
| Facility | | $1,125.31 | $3,244.31 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.87 / $809.83 / $1,948.15
| Facility | | $518.87 | $809.83 | $1,948.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.65 / $739.02 / $1,533.98
| Facility | | $449.65 | $739.02 | $1,533.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.55 / $406.15 / $940.00
| Facility | | $241.55 | $406.15 | $940.00 |
- 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 |