- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.86 / $492.86 / $4,828.00
| Facility | | $492.86 | $492.86 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,183.31 / $5,330.47 / $11,110.48
| Facility | | $2,183.31 | $5,330.47 | $11,110.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,314.77 / $1,864.51 / $4,485.34
| Facility | | $1,314.77 | $1,864.51 | $4,485.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.82 / $1,704.61 / $3,531.76
| Facility | | $1,068.82 | $1,704.61 | $3,531.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.79 / $980.94 / $7,729.00
| Facility | | $592.79 | $980.94 | $7,729.00 |
- 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 |