- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.48 / $738.48 / $6,781.00
| Facility | | $738.48 | $738.48 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,627.59 / $10,188.53 / $20,811.61
| Facility | | $3,627.59 | $10,188.53 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.75 / $2,693.45 / $6,479.46
| Facility | | $1,725.75 | $2,693.45 | $6,479.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,495.52 / $2,457.94 / $5,101.93
| Facility | | $1,495.52 | $2,457.94 | $5,101.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.32 / $1,352.66 / $2,421.31
| Facility | | $784.32 | $1,352.66 | $2,421.31 |
- 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 |