- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.66 / $597.66 / $4,828.00
| Facility | | $597.66 | $597.66 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,538.78 / $6,598.98 / $13,089.90
| Facility | | $3,538.78 | $6,598.98 | $13,089.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.69 / $2,041.29 / $4,910.60
| Facility | | $1,438.69 | $2,041.29 | $4,910.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.90 / $1,866.23 / $3,866.61
| Facility | | $1,307.90 | $1,866.23 | $3,866.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.13 / $1,010.05 / $3,500.00
| Facility | | $584.13 | $1,010.05 | $3,500.00 |
- 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 |