- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.20 / $680.20 / $4,828.00
| Facility | | $680.20 | $680.20 | $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
- $1,636.52 / $2,321.98 / $5,585.84
| Facility | | $1,636.52 | $2,321.98 | $5,585.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,487.74 / $2,122.85 / $4,398.30
| Facility | | $1,487.74 | $2,122.85 | $4,398.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.01 / $1,149.54 / $2,523.00
| Facility | | $663.01 | $1,149.54 | $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 |