- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.56 / $275.56 / $2,525.00
| Facility | | $275.56 | $275.56 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.07 / $3,084.88 / $6,762.24
| Facility | | $720.07 | $3,084.88 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.38 / $1,005.71 / $2,419.38
| Facility | | $644.38 | $1,005.71 | $2,419.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.41 / $917.78 / $1,905.03
| Facility | | $558.41 | $917.78 | $1,905.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.67 / $504.33 / $957.00
| Facility | | $300.67 | $504.33 | $957.00 |
- 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 |