- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.71 / $417.71 / $2,525.00
| Facility | | $417.71 | $417.71 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,839.15 / $3,542.66 / $7,138.18
| Facility | | $1,839.15 | $3,542.66 | $7,138.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.66 / $1,475.13 / $3,548.62
| Facility | | $1,039.66 | $1,475.13 | $3,548.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.15 / $1,348.62 / $2,794.19
| Facility | | $945.15 | $1,348.62 | $2,794.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.71 / $732.73 / $3,312.00
| Facility | | $417.71 | $732.73 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |