- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.77 / $354.77 / $4,828.00
| Facility | | $354.77 | $354.77 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,167.10 / $11,688.59
| Facility | | $2,088.76 | $5,167.10 | $11,688.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.56 / $1,226.68 / $2,950.96
| Facility | | $864.56 | $1,226.68 | $2,950.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.96 / $1,121.48 / $2,323.59
| Facility | | $785.96 | $1,121.48 | $2,323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.34 / $619.28 / $2,735.00
| Facility | | $369.34 | $619.28 | $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 |