- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.36 / $646.36 / $4,828.00
| Facility | | $646.36 | $646.36 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,964.75 / $5,385.36 / $10,098.06
| Facility | | $2,964.75 | $5,385.36 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,570.82 / $2,227.62 / $5,358.84
| Facility | | $1,570.82 | $2,227.62 | $5,358.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.97 / $2,036.58 / $4,219.56
| Facility | | $1,276.97 | $2,036.58 | $4,219.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.93 / $1,309.18 / $7,729.00
| Facility | | $882.93 | $1,309.18 | $7,729.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,312.00 / $7,414.38 / $9,468.59
| Facility | | $3,312.00 | $7,414.38 | $9,468.59 |