- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $2,238.72
| Facility | | $316.23 | $316.23 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,467.37 / $7,079.46
| Facility | | $1,905.46 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,096.48 / $2,630.27
| Facility | | $776.25 | $1,096.48 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,071.52 / $2,089.30
| Facility | | $851.14 | $1,071.52 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $549.54 / $4,677.35
| Facility | | $316.23 | $549.54 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,467.37 / $6,456.54
| Facility | | $1,000.00 | $3,467.37 | $6,456.54 |