- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.75 / $451.75 / $2,168.00
| Facility | | $451.75 | $451.75 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.42 / $3,211.09 / $6,304.59
| Facility | | $1,812.42 | $3,211.09 | $6,304.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.79 / $1,587.40 / $3,818.72
| Facility | | $1,118.79 | $1,587.40 | $3,818.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.08 / $1,451.27 / $3,006.86
| Facility | | $1,017.08 | $1,451.27 | $3,006.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.75 / $805.84 / $3,500.00
| Facility | | $451.75 | $805.84 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |