- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.43 / $743.43 / $6,781.00
| Facility | | $743.43 | $743.43 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,079.36 / $5,939.08 / $11,966.76
| Facility | | $3,079.36 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,793.10 / $2,544.15 / $6,120.29
| Facility | | $1,793.10 | $2,544.15 | $6,120.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,630.09 / $2,325.96 / $4,819.13
| Facility | | $1,630.09 | $2,325.96 | $4,819.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.43 / $1,256.40 / $3,991.00
| Facility | | $743.43 | $1,256.40 | $3,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $7,823.25 / $10,734.22
| Facility | | $3,121.00 | $7,823.25 | $10,734.22 |