- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.48 / $803.48 / $4,828.00
| Facility | | $803.48 | $803.48 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,919.06 / $6,726.72 / $13,748.55
| Facility | | $2,919.06 | $6,726.72 | $13,748.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,853.71 / $2,630.15 / $6,327.17
| Facility | | $1,853.71 | $2,630.15 | $6,327.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,507.71 / $2,404.58 / $4,982.03
| Facility | | $1,507.71 | $2,404.58 | $4,982.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.48 / $1,357.88 / $6,927.00
| Facility | | $803.48 | $1,357.88 | $6,927.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,256.00 / $4,968.00 / $9,787.00
| Facility | | $3,256.00 | $4,968.00 | $9,787.00 |