- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.24 / $509.24 / $4,828.00
| Facility | | $509.24 | $509.24 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $3,291.52 / $6,499.58
| Facility | | $2,088.76 | $3,291.52 | $6,499.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.06 / $1,789.26 / $4,304.32
| Facility | | $1,261.06 | $1,789.26 | $4,304.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.42 / $1,635.82 / $3,389.23
| Facility | | $1,146.42 | $1,635.82 | $3,389.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.24 / $866.45 / $1,444.08
| Facility | | $509.24 | $866.45 | $1,444.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.00 / $2,544.00 / $4,506.00
| Facility | | $563.00 | $2,544.00 | $4,506.00 |