- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.32 / $460.32 / $4,828.00
| Facility | | $460.32 | $460.32 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.65 / $5,927.46 / $11,503.06
| Facility | | $2,056.65 | $5,927.46 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.83 / $1,594.57 / $3,835.96
| Facility | | $1,123.83 | $1,594.57 | $3,835.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,021.68 / $1,457.82 / $3,020.44
| Facility | | $1,021.68 | $1,457.82 | $3,020.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.21 / $789.64 / $3,293.00
| Facility | | $490.21 | $789.64 | $3,293.00 |
- 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 |