- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.04 / $615.04 / $4,828.00
| Facility | | $615.04 | $615.04 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,706.64 / $5,296.37 / $10,098.06
| Facility | | $2,706.64 | $5,296.37 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,494.25 / $2,120.12 / $5,100.24
| Facility | | $1,494.25 | $2,120.12 | $5,100.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,358.41 / $1,938.30 / $4,015.94
| Facility | | $1,358.41 | $1,938.30 | $4,015.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.97 / $1,040.84 / $3,307.00
| Facility | | $561.97 | $1,040.84 | $3,307.00 |
- 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 |