- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.75 / $604.75 / $4,828.00
| Facility | | $604.75 | $604.75 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,868.80 / $12,197.67 / $25,424.06
| Facility | | $2,868.80 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,466.47 / $2,080.71 / $5,005.42
| Facility | | $1,466.47 | $2,080.71 | $5,005.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,333.15 / $1,902.26 / $3,941.28
| Facility | | $1,333.15 | $1,902.26 | $3,941.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.10 / $1,042.58 / $4,572.87
| Facility | | $629.10 | $1,042.58 | $4,572.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |