- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.74 / $497.74 / $4,828.00
| Facility | | $497.74 | $497.74 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,434.69 / $5,396.85 / $11,503.06
| Facility | | $2,434.69 | $5,396.85 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,231.59 / $1,747.46 / $4,203.75
| Facility | | $1,231.59 | $1,747.46 | $4,203.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,119.63 / $1,597.60 / $3,310.04
| Facility | | $1,119.63 | $1,597.60 | $3,310.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.92 / $885.39 / $3,991.00
| Facility | | $532.92 | $885.39 | $3,991.00 |
- 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 |