- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.85 / $312.45 / $2,525.00
| Facility | | $149.85 | $312.45 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.63 / $3,675.96 / $8,304.51
| Facility | | $653.63 | $3,675.96 | $8,304.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.61 / $1,022.44 / $2,459.61
| Facility | | $720.61 | $1,022.44 | $2,459.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.70 / $934.75 / $1,936.70
| Facility | | $567.70 | $934.75 | $1,936.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.87 / $319.02 / $876.58
| Facility | | $152.87 | $319.02 | $876.58 |
- 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 |