- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.73 / $454.73 / $6,575.00
| Facility | | $454.73 | $454.73 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,049.67 / $4,787.28 / $10,305.75
| Facility | | $2,049.67 | $4,787.28 | $10,305.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.30 / $1,662.65 / $3,999.74
| Facility | | $1,065.30 | $1,662.65 | $3,999.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.17 / $1,517.28 / $3,149.40
| Facility | | $923.17 | $1,517.28 | $3,149.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.90 / $861.29 / $2,735.00
| Facility | | $474.90 | $861.29 | $2,735.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.00 / $4,746.00 / $8,812.00
| Facility | | $1,623.00 | $4,746.00 | $8,812.00 |