- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.52 / $480.52 / $4,828.00
| Facility | | $480.52 | $480.52 | $4,828.00 |
- 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
- $1,168.46 / $1,657.88 / $3,988.24
| Facility | | $1,168.46 | $1,657.88 | $3,988.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.24 / $1,515.70 / $3,140.35
| Facility | | $1,062.24 | $1,515.70 | $3,140.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.16 / $814.23 / $2,735.00
| Facility | | $485.16 | $814.23 | $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 |