- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.87 / $528.87 / $6,575.00
| Facility | | $528.87 | $528.87 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $3,444.15 / $6,499.58
| Facility | | $2,088.76 | $3,444.15 | $6,499.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.36 / $1,832.26 / $4,407.76
| Facility | | $1,291.36 | $1,832.26 | $4,407.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.97 / $1,675.13 / $3,470.68
| Facility | | $1,173.97 | $1,675.13 | $3,470.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.07 / $903.44 / $1,600.19
| Facility | | $575.07 | $903.44 | $1,600.19 |
- 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 |