- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.65 / $683.65 / $6,781.00
| Facility | | $683.65 | $683.65 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,420.34 / $3,825.02 / $8,281.67
| Facility | | $1,420.34 | $3,825.02 | $8,281.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,589.38 / $2,255.09 / $5,424.93
| Facility | | $1,589.38 | $2,255.09 | $5,424.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.71 / $2,061.69 / $4,271.60
| Facility | | $1,292.71 | $2,061.69 | $4,271.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.19 / $1,190.06 / $5,499.18
| Facility | | $730.19 | $1,190.06 | $5,499.18 |
- 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 |