- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.69 / $226.69 / $2,525.00
| Facility | | $226.69 | $226.69 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.56 / $3,310.52 / $6,762.24
| Facility | | $1,152.56 | $3,310.52 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.35 / $827.74 / $1,991.25
| Facility | | $530.35 | $827.74 | $1,991.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.60 / $755.37 / $1,567.91
| Facility | | $459.60 | $755.37 | $1,567.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.50 / $415.97 / $841.50
| Facility | | $247.50 | $415.97 | $841.50 |
- 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 |