- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.41 / $459.41 / $4,828.00
| Facility | | $459.41 | $459.41 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,579.43 / $5,091.78 / $11,503.06
| Facility | | $1,579.43 | $5,091.78 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.00 / $1,593.38 / $3,833.08
| Facility | | $1,123.00 | $1,593.38 | $3,833.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.91 / $1,456.73 / $3,018.18
| Facility | | $1,020.91 | $1,456.73 | $3,018.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.91 / $806.01 / $5,577.00
| Facility | | $464.91 | $806.01 | $5,577.00 |
- 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 |