- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.32 / $662.32 / $4,828.00
| Facility | | $662.32 | $662.32 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,994.17 / $5,385.36 / $10,633.01
| Facility | | $2,994.17 | $5,385.36 | $10,633.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,667.68 / $2,364.98 / $5,689.28
| Facility | | $1,667.68 | $2,364.98 | $5,689.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,355.71 / $2,162.16 / $4,479.75
| Facility | | $1,355.71 | $2,162.16 | $4,479.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.16 / $1,144.22 / $4,974.00
| Facility | | $743.16 | $1,144.22 | $4,974.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |