- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.73 / $988.73 / $4,828.00
| Facility | | $988.73 | $988.73 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,677.15 / $6,337.44 / $11,491.08
| Facility | | $3,677.15 | $6,337.44 | $11,491.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,395.85 / $3,399.36 / $8,177.63
| Facility | | $2,395.85 | $3,399.36 | $8,177.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,178.04 / $3,107.83 / $6,439.08
| Facility | | $2,178.04 | $3,107.83 | $6,439.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.28 / $1,692.40 / $2,956.35
| Facility | | $1,067.28 | $1,692.40 | $2,956.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |