- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.39 / $681.39 / $4,828.00
| Facility | | $681.39 | $681.39 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $3,798.60 / $6,499.58
| Facility | | $2,088.76 | $3,798.60 | $6,499.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,645.78 / $2,335.12 / $5,617.45
| Facility | | $1,645.78 | $2,335.12 | $5,617.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,496.16 / $2,134.86 / $4,423.18
| Facility | | $1,496.16 | $2,134.86 | $4,423.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.40 / $1,162.57 / $3,312.00
| Facility | | $696.40 | $1,162.57 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |