- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.54 / $482.54 / $4,828.00
| Facility | | $482.54 | $482.54 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,417.89 / $9,539.56
| Facility | | $2,088.76 | $4,417.89 | $9,539.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,163.41 / $1,650.71 / $3,971.00
| Facility | | $1,163.41 | $1,650.71 | $3,971.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,057.64 / $1,509.14 / $3,126.78
| Facility | | $1,057.64 | $1,509.14 | $3,126.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.20 / $815.49 / $2,523.00
| Facility | | $459.20 | $815.49 | $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 |