- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.74 / $508.74 / $2,525.00
| Facility | | $508.74 | $508.74 | $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
- $1,246.75 / $1,768.96 / $4,255.47
| Facility | | $1,246.75 | $1,768.96 | $4,255.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.41 / $1,617.25 / $3,350.76
| Facility | | $1,133.41 | $1,617.25 | $3,350.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.12 / $876.26 / $3,293.00
| Facility | | $533.12 | $876.26 | $3,293.00 |
- 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 |