- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.37 / $610.37 / $4,828.00
| Facility | | $610.37 | $610.37 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,706.64 / $5,277.65 / $10,505.12
| Facility | | $2,706.64 | $5,277.65 | $10,505.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,511.86 / $2,144.01 / $5,157.71
| Facility | | $1,511.86 | $2,144.01 | $5,157.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.04 / $1,960.14 / $4,061.19
| Facility | | $1,229.04 | $1,960.14 | $4,061.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.64 / $1,031.53 / $3,500.00
| Facility | | $672.64 | $1,031.53 | $3,500.00 |
- 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 |