- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.44 / $599.44 / $6,781.00
| Facility | | $599.44 | $599.44 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,628.92 / $5,907.47 / $11,903.07
| Facility | | $2,628.92 | $5,907.47 | $11,903.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,467.31 / $2,081.90 / $5,008.29
| Facility | | $1,467.31 | $2,081.90 | $5,008.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,333.92 / $1,903.36 / $3,943.54
| Facility | | $1,333.92 | $1,903.36 | $3,943.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.44 / $1,045.33 / $4,273.00
| Facility | | $599.44 | $1,045.33 | $4,273.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |