- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.67 / $355.67 / $2,168.00
| Facility | | $355.67 | $355.67 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,436.47 / $6,598.98 / $13,089.90
| Facility | | $3,436.47 | $6,598.98 | $13,089.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.66 / $1,241.02 / $2,985.44
| Facility | | $874.66 | $1,241.02 | $2,985.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.15 / $1,134.58 / $2,350.73
| Facility | | $795.15 | $1,134.58 | $2,350.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.67 / $615.02 / $2,735.00
| Facility | | $355.67 | $615.02 | $2,735.00 |
- 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 |