- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.72 / $422.37 / $2,525.00
| Facility | | $219.72 | $422.37 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.95 / $1,918.16 / $4,193.72
| Facility | | $478.95 | $1,918.16 | $4,193.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.18 / $1,502.61 / $3,695.16
| Facility | | $984.18 | $1,502.61 | $3,695.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.88 / $1,264.14 / $2,909.58
| Facility | | $852.88 | $1,264.14 | $2,909.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $632.46 / $1,238.26
| Facility | | $316.23 | $632.46 | $1,238.26 |
- 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 |