- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.56 / $391.56 / $2,525.00
| Facility | | $391.56 | $391.56 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,675.14 / $4,065.55 / $8,304.51
| Facility | | $1,675.14 | $4,065.55 | $8,304.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.54 / $1,294.77 / $3,114.74
| Facility | | $912.54 | $1,294.77 | $3,114.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.21 / $1,183.73 / $2,452.55
| Facility | | $742.21 | $1,183.73 | $2,452.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.81 / $675.97 / $5,625.11
| Facility | | $379.81 | $675.97 | $5,625.11 |
- 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 |