- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.83 / $638.83 / $6,575.00
| Facility | | $638.83 | $638.83 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,692.76 / $9,458.16 / $20,811.61
| Facility | | $2,692.76 | $9,458.16 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.70 / $2,099.82 / $5,051.39
| Facility | | $1,480.70 | $2,099.82 | $5,051.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,203.70 / $1,919.74 / $3,977.48
| Facility | | $1,203.70 | $1,919.74 | $3,977.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.87 / $1,184.33 / $10,533.00
| Facility | | $740.87 | $1,184.33 | $10,533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $8,689.00 / $11,531.00
| Facility | | $3,940.00 | $8,689.00 | $11,531.00 |