- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.27 / $636.27 / $4,828.00
| Facility | | $636.27 | $636.27 | $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
- $1,526.24 / $2,165.51 / $5,209.43
| Facility | | $1,526.24 | $2,165.51 | $5,209.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.49 / $1,979.80 / $4,101.91
| Facility | | $1,387.49 | $1,979.80 | $4,101.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.74 / $1,075.30 / $2,861.13
| Facility | | $622.74 | $1,075.30 | $2,861.13 |
- 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 |