- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.10 / $176.10 / $2,525.00
| Facility | | $176.10 | $176.10 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.06 / $3,084.88 / $6,762.24
| Facility | | $916.06 | $3,084.88 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.50 / $643.79 / $1,548.75
| Facility | | $412.50 | $643.79 | $1,548.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.46 / $587.51 / $1,219.49
| Facility | | $357.46 | $587.51 | $1,219.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.04 / $324.16 / $852.00
| Facility | | $193.04 | $324.16 | $852.00 |
- 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 |