- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.93 / $456.93 / $4,828.00
| Facility | | $456.93 | $456.93 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.69 / $3,825.02 / $8,281.67
| Facility | | $1,001.69 | $3,825.02 | $8,281.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.76 / $1,512.15 / $3,637.69
| Facility | | $1,065.76 | $1,512.15 | $3,637.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.83 / $1,382.47 / $2,864.33
| Facility | | $866.83 | $1,382.47 | $2,864.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.36 / $808.10 / $4,013.00
| Facility | | $495.36 | $808.10 | $4,013.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |