- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $588.84 / $588.84
| Facility | | $151.36 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,715.35 / $8,709.64
| Facility | | $1,000.00 | $3,715.35 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,238.72 / $5,370.32
| Facility | | $1,412.54 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,137.96 / $4,265.80
| Facility | | $1,737.80 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $501.19 / $1,698.24
| Facility | | $181.97 | $501.19 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,467.37 / $6,456.54
| Facility | | $1,445.44 | $3,467.37 | $6,456.54 |