- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.91 / $822.91 / $3,638.00
| Facility | | $822.91 | $822.91 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,704.53 / $11,118.44 / $23,174.60
| Facility | | $3,704.53 | $11,118.44 | $23,174.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,951.53 / $2,767.51 / $6,657.61
| Facility | | $1,951.53 | $2,767.51 | $6,657.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.45 / $2,530.16 / $5,242.21
| Facility | | $1,586.45 | $2,530.16 | $5,242.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.63 / $1,507.68 / $8,313.00
| Facility | | $813.63 | $1,507.68 | $8,313.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,312.00 / $8,193.00 / $21,575.09
| Facility | | $3,312.00 | $8,193.00 | $21,575.09 |