- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.28 / $903.00 / $5,449.00
| Facility | | $471.28 | $903.00 | $5,449.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.61 / $1,457.61 / $1,478.88
| Facility | | $1,457.61 | $1,457.61 | $1,478.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $1,587.44
| Facility | | $395.75 | $395.75 | $1,587.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.28 / $796.15 / $1,261.24
| Facility | | $471.28 | $796.15 | $1,261.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,169.88 / $2,335.77 / $12,000.00
| Facility | | $2,169.88 | $2,335.77 | $12,000.00 |