- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.34 / $345.34 / $345.34
| Facility | | $345.34 | $345.34 | $345.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.86 / $8,644.58 / $19,529.31
| Facility | | $1,665.86 | $8,644.58 | $19,529.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.93 / $1,083.34 / $2,606.15
| Facility | | $763.93 | $1,083.34 | $2,606.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.02 / $990.44 / $2,052.09
| Facility | | $621.02 | $990.44 | $2,052.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.15 / $629.33 / $3,500.00
| Facility | | $539.15 | $629.33 | $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 |