- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.91 / $482.91 / $6,575.00
| Facility | | $482.91 | $482.91 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,197.71 / $5,939.08 / $11,503.06
| Facility | | $2,197.71 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.56 / $1,672.21 / $4,022.73
| Facility | | $1,178.56 | $1,672.21 | $4,022.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.42 / $1,528.80 / $3,167.50
| Facility | | $1,071.42 | $1,528.80 | $3,167.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.75 / $847.17 / $3,293.00
| Facility | | $488.75 | $847.17 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |