- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.57 / $519.57 / $2,525.00
| Facility | | $519.57 | $519.57 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.67 / $7,465.39 / $14,249.16
| Facility | | $4,206.67 | $7,465.39 | $14,249.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.95 / $1,797.62 / $4,324.43
| Facility | | $1,266.95 | $1,797.62 | $4,324.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.78 / $1,643.46 / $3,405.06
| Facility | | $1,151.78 | $1,643.46 | $3,405.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.83 / $888.30 / $2,735.00
| Facility | | $522.83 | $888.30 | $2,735.00 |
- 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 |