- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.05 / $583.05 / $2,525.00
| Facility | | $583.05 | $583.05 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.67 / $7,465.39 / $14,249.16
| Facility | | $4,206.67 | $7,465.39 | $14,249.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,418.48 / $2,012.62 / $4,841.64
| Facility | | $1,418.48 | $2,012.62 | $4,841.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.53 / $1,840.02 / $3,812.31
| Facility | | $1,289.53 | $1,840.02 | $3,812.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.84 / $997.43 / $2,742.50
| Facility | | $590.84 | $997.43 | $2,742.50 |
- 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 |