- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.55 / $494.55 / $3,442.00
| Facility | | $494.55 | $494.55 | $3,442.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,431.96 / $9,458.16 / $20,811.61
| Facility | | $2,431.96 | $9,458.16 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.43 / $1,809.57 / $4,353.16
| Facility | | $1,159.43 | $1,809.57 | $4,353.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.75 / $1,651.35 / $3,427.69
| Facility | | $1,004.75 | $1,651.35 | $3,427.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.57 / $910.13 / $1,612.86
| Facility | | $516.57 | $910.13 | $1,612.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $7,872.00 / $11,531.00
| Facility | | $2,960.00 | $7,872.00 | $11,531.00 |