- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.85 / $587.85 / $4,828.00
| Facility | | $587.85 | $587.85 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,768.64 / $6,134.65 / $11,503.06
| Facility | | $2,768.64 | $6,134.65 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,431.11 / $2,030.54 / $4,884.74
| Facility | | $1,431.11 | $2,030.54 | $4,884.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.01 / $1,856.40 / $3,846.25
| Facility | | $1,301.01 | $1,856.40 | $3,846.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.71 / $1,025.59 / $7,556.70
| Facility | | $604.71 | $1,025.59 | $7,556.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |