- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.82 / $581.82 / $4,828.00
| Facility | | $581.82 | $581.82 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,678.61 / $5,939.08 / $11,966.76
| Facility | | $2,678.61 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,415.96 / $2,009.04 / $4,833.02
| Facility | | $1,415.96 | $2,009.04 | $4,833.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,287.23 / $1,836.74 / $3,805.53
| Facility | | $1,287.23 | $1,836.74 | $3,805.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.91 / $1,011.95 / $5,499.00
| Facility | | $602.91 | $1,011.95 | $5,499.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |