- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.54 / $274.54 / $6,575.00
| Facility | | $274.54 | $274.54 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,098.09 / $3,628.46 / $7,137.18
| Facility | | $2,098.09 | $3,628.46 | $7,137.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.14 / $1,043.94 / $2,511.33
| Facility | | $736.14 | $1,043.94 | $2,511.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.42 / $954.41 / $1,977.43
| Facility | | $598.42 | $954.41 | $1,977.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.93 / $611.37 / $4,197.35
| Facility | | $423.93 | $611.37 | $4,197.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,523.00 / $4,233.70 / $6,361.00
| Facility | | $2,523.00 | $4,233.70 | $6,361.00 |