- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.32 / $266.32 / $2,525.00
| Facility | | $266.32 | $266.32 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,160.73 / $3,542.66 / $6,861.58
| Facility | | $1,160.73 | $3,542.66 | $6,861.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $664.20 / $942.41 / $2,267.09
| Facility | | $664.20 | $942.41 | $2,267.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.82 / $861.59 / $1,785.11
| Facility | | $603.82 | $861.59 | $1,785.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.52 / $497.68 / $3,312.00
| Facility | | $302.52 | $497.68 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |