- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.40 / $542.40 / $6,575.00
| Facility | | $542.40 | $542.40 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.67 / $7,465.39 / $14,249.16
| Facility | | $4,206.67 | $7,465.39 | $14,249.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.67 / $1,875.26 / $4,511.20
| Facility | | $1,321.67 | $1,875.26 | $4,511.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,201.52 / $1,714.44 / $3,552.13
| Facility | | $1,201.52 | $1,714.44 | $3,552.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.36 / $1,029.50 / $4,746.00
| Facility | | $548.36 | $1,029.50 | $4,746.00 |
- 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 |