- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.63 / $404.63 / $4,828.00
| Facility | | $404.63 | $404.63 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,677.15 / $6,553.55 / $13,208.54
| Facility | | $3,677.15 | $6,553.55 | $13,208.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.57 / $1,392.71 / $3,350.36
| Facility | | $981.57 | $1,392.71 | $3,350.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $892.34 / $1,273.27 / $2,638.08
| Facility | | $892.34 | $1,273.27 | $2,638.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.63 / $794.28 / $4,746.00
| Facility | | $419.63 | $794.28 | $4,746.00 |
- 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 |