- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.16 / $519.16 / $4,828.00
| Facility | | $519.16 | $519.16 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,351.60 / $5,939.08 / $11,503.06
| Facility | | $2,351.60 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.90 / $1,790.46 / $4,307.18
| Facility | | $1,261.90 | $1,790.46 | $4,307.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,147.18 / $1,636.91 / $3,391.49
| Facility | | $1,147.18 | $1,636.91 | $3,391.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.22 / $889.16 / $3,293.00
| Facility | | $523.22 | $889.16 | $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 |