- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.17 / $539.17 / $2,168.00
| Facility | | $539.17 | $539.17 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,433.35 / $5,939.08 / $11,503.06
| Facility | | $2,433.35 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,325.88 / $1,881.24 / $4,525.57
| Facility | | $1,325.88 | $1,881.24 | $4,525.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,205.34 / $1,719.90 / $3,563.44
| Facility | | $1,205.34 | $1,719.90 | $3,563.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.17 / $930.83 / $2,735.00
| Facility | | $539.17 | $930.83 | $2,735.00 |
- 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 |