- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.18 / $504.18 / $6,781.00
| Facility | | $504.18 | $504.18 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,298.94 / $5,330.47 / $11,558.36
| Facility | | $2,298.94 | $5,330.47 | $11,558.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,338.36 / $1,897.96 / $4,565.79
| Facility | | $1,338.36 | $1,897.96 | $4,565.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.99 / $1,735.19 / $3,595.11
| Facility | | $1,087.99 | $1,735.19 | $3,595.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.15 / $1,044.15 / $5,499.00
| Facility | | $643.15 | $1,044.15 | $5,499.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |