- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.19 / $485.19 / $2,525.00
| Facility | | $485.19 | $485.19 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,233.39 / $7,215.03 / $14,098.13
| Facility | | $4,233.39 | $7,215.03 | $14,098.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.46 / $1,844.21 / $4,436.49
| Facility | | $1,300.46 | $1,844.21 | $4,436.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,057.18 / $1,686.05 / $3,493.30
| Facility | | $1,057.18 | $1,686.05 | $3,493.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.39 / $1,085.58 / $7,770.00
| Facility | | $710.39 | $1,085.58 | $7,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |