- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $9,120.11
| Facility | | $537.03 | $537.03 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,623.41 / $12,589.25
| Facility | | $2,754.23 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,995.26 / $4,786.30
| Facility | | $1,412.54 | $1,995.26 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $3,715.35
| Facility | | $1,513.56 | $1,905.46 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,096.48 / $6,918.31
| Facility | | $537.03 | $1,096.48 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,495.41 / $10,000.00
| Facility | | $3,090.30 | $5,495.41 | $10,000.00 |