- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.87 / $511.87 / $4,828.00
| Facility | | $511.87 | $511.87 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.31 / $5,710.32 / $11,503.06
| Facility | | $1,981.31 | $5,710.32 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,241.70 / $1,761.79 / $4,238.22
| Facility | | $1,241.70 | $1,761.79 | $4,238.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.82 / $1,610.70 / $3,337.19
| Facility | | $1,128.82 | $1,610.70 | $3,337.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.87 / $876.62 / $2,735.00
| Facility | | $511.87 | $876.62 | $2,735.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |