- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.07 / $670.07 / $4,828.00
| Facility | | $670.07 | $670.07 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,025.71 / $5,385.36 / $10,744.99
| Facility | | $3,025.71 | $5,385.36 | $10,744.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,688.74 / $2,394.84 / $5,761.12
| Facility | | $1,688.74 | $2,394.84 | $5,761.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,372.82 / $2,189.46 / $4,536.31
| Facility | | $1,372.82 | $2,189.46 | $4,536.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.72 / $1,166.83 / $4,974.00
| Facility | | $753.72 | $1,166.83 | $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 |