- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.52 / $1,831.47 / $6,953.60
| Facility | | $257.52 | $1,831.47 | $6,953.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,826.12 / $2,008.73 / $3,408.75
| Facility | | $1,826.12 | $2,008.73 | $3,408.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $1,731.47 / $3,266.42
| Facility | | $443.00 | $1,731.47 | $3,266.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.52 / $1,172.14 / $1,788.14
| Facility | | $257.52 | $1,172.14 | $1,788.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.00 / $1,557.00 / $11,999.00
| Facility | | $902.00 | $1,557.00 | $11,999.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,466.75 / $1,466.75
| Facility | | $55.00 | $1,466.75 | $1,466.75 |