- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.95 / $607.95 / $4,828.00
| Facility | | $607.95 | $607.95 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.16 / $3,825.02 / $8,281.67
| Facility | | $1,282.16 | $3,825.02 | $8,281.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,418.48 / $2,012.62 / $4,841.64
| Facility | | $1,418.48 | $2,012.62 | $4,841.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.72 / $1,840.02 / $3,812.31
| Facility | | $1,153.72 | $1,840.02 | $3,812.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.24 / $1,058.29 / $5,499.18
| Facility | | $629.24 | $1,058.29 | $5,499.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,312.00 / $5,959.58 / $8,812.00
| Facility | | $3,312.00 | $5,959.58 | $8,812.00 |