- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.05 / $490.05 / $4,828.00
| Facility | | $490.05 | $490.05 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.59 / $5,939.08 / $11,503.06
| Facility | | $2,343.59 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,195.40 / $1,696.10 / $4,080.19
| Facility | | $1,195.40 | $1,696.10 | $4,080.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.73 / $1,550.64 / $3,212.75
| Facility | | $1,086.73 | $1,550.64 | $3,212.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.00 / $846.16 / $2,735.00
| Facility | | $493.00 | $846.16 | $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 |