- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.57 / $622.57 / $6,781.00
| Facility | | $622.57 | $622.57 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,824.49 / $5,939.08 / $11,966.76
| Facility | | $2,824.49 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,516.98 / $2,152.37 / $5,177.82
| Facility | | $1,516.98 | $2,152.37 | $5,177.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.07 / $1,967.78 / $4,077.03
| Facility | | $1,379.07 | $1,967.78 | $4,077.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.23 / $1,065.59 / $4,273.00
| Facility | | $628.23 | $1,065.59 | $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 |