- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.69 / $910.69 / $3,638.00
| Facility | | $910.69 | $910.69 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,010.71 / $10,188.53 / $20,811.61
| Facility | | $4,010.71 | $10,188.53 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.11 / $3,202.28 / $7,703.52
| Facility | | $2,258.11 | $3,202.28 | $7,703.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,835.68 / $2,927.65 / $6,065.76
| Facility | | $1,835.68 | $2,927.65 | $6,065.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,134.45 / $1,855.79 / $7,770.00
| Facility | | $1,134.45 | $1,855.79 | $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 |