- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.18 / $990.18 / $6,582.00
| Facility | | $990.18 | $990.18 | $6,582.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,896.53 / $3,456.22 / $6,480.74
| Facility | | $1,896.53 | $3,456.22 | $6,480.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,469.52 / $3,502.08 / $8,424.74
| Facility | | $2,469.52 | $3,502.08 | $8,424.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,007.54 / $3,201.74 / $6,633.65
| Facility | | $2,007.54 | $3,201.74 | $6,633.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.32 / $1,657.55 / $3,500.00
| Facility | | $1,024.32 | $1,657.55 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |