- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.43 / $504.43 / $4,828.00
| Facility | | $504.43 | $504.43 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,144.27 / $5,396.85 / $11,503.06
| Facility | | $2,144.27 | $5,396.85 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.85 / $1,737.90 / $4,180.76
| Facility | | $1,224.85 | $1,737.90 | $4,180.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.51 / $1,588.86 / $3,291.94
| Facility | | $1,113.51 | $1,588.86 | $3,291.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.88 / $883.87 / $4,093.00
| Facility | | $508.88 | $883.87 | $4,093.00 |
- 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 |