- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.74 / $648.74 / $6,575.00
| Facility | | $648.74 | $648.74 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,385.51 / $11,583.70 / $26,641.14
| Facility | | $3,385.51 | $11,583.70 | $26,641.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.76 / $2,362.59 / $5,683.54
| Facility | | $1,513.76 | $2,362.59 | $5,683.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.81 / $2,156.02 / $4,475.22
| Facility | | $1,311.81 | $2,156.02 | $4,475.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.90 / $1,195.45 / $2,193.86
| Facility | | $703.90 | $1,195.45 | $2,193.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $5,499.00 / $9,810.00
| Facility | | $2,100.00 | $5,499.00 | $9,810.00 |