- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.05 / $464.05 / $4,828.00
| Facility | | $464.05 | $464.05 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.58 / $7,824.33 / $17,676.25
| Facility | | $2,234.58 | $7,824.33 | $17,676.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.07 / $1,748.65 / $4,206.62
| Facility | | $1,233.07 | $1,748.65 | $4,206.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.40 / $1,598.69 / $3,312.30
| Facility | | $1,002.40 | $1,598.69 | $3,312.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.44 / $980.23 / $7,770.00
| Facility | | $616.44 | $980.23 | $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 |