- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.75 / $653.75 / $6,575.00
| Facility | | $653.75 | $653.75 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,947.92 / $5,939.08 / $11,966.76
| Facility | | $2,947.92 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,585.17 / $2,249.12 / $5,410.57
| Facility | | $1,585.17 | $2,249.12 | $5,410.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,441.06 / $2,056.23 / $4,260.29
| Facility | | $1,441.06 | $2,056.23 | $4,260.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.75 / $1,104.83 / $3,312.00
| Facility | | $653.75 | $1,104.83 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |