- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.04 / $619.04 / $6,575.00
| Facility | | $619.04 | $619.04 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,842.12 / $5,939.08 / $11,966.76
| Facility | | $2,842.12 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,510.24 / $2,142.82 / $5,154.83
| Facility | | $1,510.24 | $2,142.82 | $5,154.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,372.95 / $1,959.05 / $4,058.93
| Facility | | $1,372.95 | $1,959.05 | $4,058.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.58 / $1,084.06 / $3,991.00
| Facility | | $632.58 | $1,084.06 | $3,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $3,991.00 / $9,787.00
| Facility | | $2,740.00 | $3,991.00 | $9,787.00 |