- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.32 / $628.32 / $4,828.00
| Facility | | $628.32 | $628.32 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,376.30 / $9,046.11
| Facility | | $2,088.76 | $4,376.30 | $9,046.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,514.45 / $2,148.79 / $5,169.20
| Facility | | $1,514.45 | $2,148.79 | $5,169.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.77 / $1,964.51 / $4,070.24
| Facility | | $1,376.77 | $1,964.51 | $4,070.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.92 / $1,061.85 / $2,523.00
| Facility | | $612.92 | $1,061.85 | $2,523.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |