- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.96 / $392.96 / $4,828.00
| Facility | | $392.96 | $392.96 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,792.15 / $3,542.66 / $7,138.18
| Facility | | $1,792.15 | $3,542.66 | $7,138.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $992.52 / $1,408.24 / $3,387.71
| Facility | | $992.52 | $1,408.24 | $3,387.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.29 / $1,287.47 / $2,667.49
| Facility | | $902.29 | $1,287.47 | $2,667.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.96 / $691.72 / $4,671.00
| Facility | | $392.96 | $691.72 | $4,671.00 |
- 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 |