- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $380.19 / $380.19
| Facility | | $302.00 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $6,606.93 / $15,848.93
| Facility | | $776.25 | $6,606.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,445.44 / $3,467.37
| Facility | | $1,023.29 | $1,445.44 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,380.38 / $2,754.23
| Facility | | $1,122.02 | $1,380.38 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $691.83 / $4,677.35
| Facility | | $436.52 | $691.83 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,467.37 / $8,912.51
| Facility | | $1,000.00 | $3,467.37 | $8,912.51 |