- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $912.01 / $912.01
| Facility | | $128.82 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $724.44 / $1,737.80
| Facility | | $1.00 | $724.44 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,951.21 / $6,918.31
| Facility | | $1,995.26 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,691.53 / $5,495.41
| Facility | | $2,238.72 | $2,691.53 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $1,258.93 / $2,398.83
| Facility | | $177.83 | $1,258.93 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,089.30 / $3,467.37
| Facility | | $1,445.44 | $2,089.30 | $3,467.37 |