- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.59 / $344.59 / $4,828.00
| Facility | | $344.59 | $344.59 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.67 / $7,465.39 / $14,249.16
| Facility | | $4,206.67 | $7,465.39 | $14,249.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.56 / $1,226.68 / $2,950.96
| Facility | | $864.56 | $1,226.68 | $2,950.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.96 / $1,121.48 / $2,323.59
| Facility | | $785.96 | $1,121.48 | $2,323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.59 / $603.40 / $2,735.00
| Facility | | $344.59 | $603.40 | $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 |