- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.63 / $362.63 / $2,256.00
| Facility | | $362.63 | $362.63 | $2,256.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,555.36 / $4,880.39 / $11,224.34
| Facility | | $1,555.36 | $4,880.39 | $11,224.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.73 / $1,122.77 / $2,700.97
| Facility | | $791.73 | $1,122.77 | $2,700.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.62 / $1,026.48 / $2,126.75
| Facility | | $643.62 | $1,026.48 | $2,126.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.07 / $652.04 / $3,500.00
| Facility | | $561.07 | $652.04 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |