- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.52 / $280.52 / $2,525.00
| Facility | | $280.52 | $280.52 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,337.92 / $2,335.94 / $4,629.08
| Facility | | $1,337.92 | $2,335.94 | $4,629.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.86 / $1,023.63 / $2,462.48
| Facility | | $655.86 | $1,023.63 | $2,462.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.36 / $934.13 / $1,938.96
| Facility | | $568.36 | $934.13 | $1,938.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.94 / $522.24 / $990.46
| Facility | | $313.94 | $522.24 | $990.46 |
- 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 |