- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.09 / $511.09 / $4,828.00
| Facility | | $511.09 | $511.09 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,308.32 / $5,939.08 / $11,503.06
| Facility | | $2,308.32 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.91 / $1,767.76 / $4,252.60
| Facility | | $1,245.91 | $1,767.76 | $4,252.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,132.64 / $1,616.16 / $3,348.50
| Facility | | $1,132.64 | $1,616.16 | $3,348.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.49 / $1,037.23 / $3,293.00
| Facility | | $557.49 | $1,037.23 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |