- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.96 / $529.96 / $4,828.00
| Facility | | $529.96 | $529.96 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,516.71 / $5,939.08 / $11,853.50
| Facility | | $2,516.71 | $5,939.08 | $11,853.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.83 / $1,851.37 / $4,453.72
| Facility | | $1,304.83 | $1,851.37 | $4,453.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.22 / $1,692.60 / $3,506.88
| Facility | | $1,186.22 | $1,692.60 | $3,506.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.60 / $934.01 / $3,293.00
| Facility | | $580.60 | $934.01 | $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 |