- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.21 / $354.21 / $2,525.00
| Facility | | $354.21 | $354.21 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.15 / $3,084.88 / $6,762.24
| Facility | | $926.15 | $3,084.88 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.82 / $1,293.57 / $3,111.87
| Facility | | $828.82 | $1,293.57 | $3,111.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.25 / $1,180.47 / $2,450.29
| Facility | | $718.25 | $1,180.47 | $2,450.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.03 / $648.87 / $1,154.91
| Facility | | $387.03 | $648.87 | $1,154.91 |
- 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 |