- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $2,915.00 / $4,124.00
| Facility | | $973.00 | $2,915.00 | $4,124.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.00 / $2,071.00 / $2,775.00
| Facility | | $816.00 | $2,071.00 | $2,775.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,396.14 / $2,465.00 / $7,499.00
| Facility | | $1,396.14 | $2,465.00 | $7,499.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.66 / $1,122.00 / $2,488.56
| Facility | | $354.66 | $1,122.00 | $2,488.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.00 / $2,071.00 / $2,775.00
| Facility | | $816.00 | $2,071.00 | $2,775.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.00 / $1,035.00 / $2,213.00
| Facility | | $430.00 | $1,035.00 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.04 / $1,629.81 / $2,652.37
| Facility | | $583.04 | $1,629.81 | $2,652.37 |