- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.98 / $508.98 / $4,828.00
| Facility | | $508.98 | $508.98 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,292.29 / $5,939.08 / $11,503.06
| Facility | | $2,292.29 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.85 / $1,760.60 / $4,235.35
| Facility | | $1,240.85 | $1,760.60 | $4,235.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.05 / $1,609.61 / $3,334.93
| Facility | | $1,128.05 | $1,609.61 | $3,334.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.04 / $1,008.56 / $3,991.00
| Facility | | $554.04 | $1,008.56 | $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 |