- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.78 / $330.78 / $2,525.00
| Facility | | $330.78 | $330.78 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,376.30 / $9,046.11
| Facility | | $2,088.76 | $4,376.30 | $9,046.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $809.00 / $1,147.84 / $2,761.31
| Facility | | $809.00 | $1,147.84 | $2,761.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.45 / $1,049.41 / $2,174.26
| Facility | | $735.45 | $1,049.41 | $2,174.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.78 / $579.94 / $2,523.00
| Facility | | $330.78 | $579.94 | $2,523.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |