- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.43 / $177.43 / $2,525.00
| Facility | | $177.43 | $177.43 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,635.84 / $4,913.74 / $10,134.11
| Facility | | $2,635.84 | $4,913.74 | $10,134.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.09 / $680.83 / $1,637.82
| Facility | | $480.09 | $680.83 | $1,637.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.28 / $622.44 / $1,289.63
| Facility | | $390.28 | $622.44 | $1,289.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.21 / $397.52 / $5,306.83
| Facility | | $241.21 | $397.52 | $5,306.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |