- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.30 / $360.30 / $7,397.00
| Facility | | $360.30 | $360.30 | $7,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.26 / $4,787.28 / $9,978.29
| Facility | | $1,665.26 | $4,787.28 | $9,978.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.66 / $1,319.85 / $3,175.08
| Facility | | $845.66 | $1,319.85 | $3,175.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.84 / $1,204.45 / $2,500.06
| Facility | | $732.84 | $1,204.45 | $2,500.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.93 / $665.91 / $1,197.50
| Facility | | $379.93 | $665.91 | $1,197.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $4,506.00 / $9,404.00
| Facility | | $2,100.00 | $4,506.00 | $9,404.00 |