- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.35 / $589.35 / $4,828.00
| Facility | | $589.35 | $589.35 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,492.64 / $5,396.85 / $11,503.06
| Facility | | $2,492.64 | $5,396.85 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,435.32 / $2,036.51 / $4,899.10
| Facility | | $1,435.32 | $2,036.51 | $4,899.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.83 / $1,861.86 / $3,857.56
| Facility | | $1,304.83 | $1,861.86 | $3,857.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.45 / $1,031.25 / $3,293.00
| Facility | | $596.45 | $1,031.25 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,051.00 / $4,506.00 / $9,787.00
| Facility | | $3,051.00 | $4,506.00 | $9,787.00 |