- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.80 / $563.80 / $2,525.00
| Facility | | $563.80 | $563.80 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,538.78 / $6,598.98 / $13,089.90
| Facility | | $3,538.78 | $6,598.98 | $13,089.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,373.02 / $1,948.12 / $4,686.47
| Facility | | $1,373.02 | $1,948.12 | $4,686.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.20 / $1,781.05 / $3,690.14
| Facility | | $1,248.20 | $1,781.05 | $3,690.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.91 / $961.06 / $2,296.00
| Facility | | $533.91 | $961.06 | $2,296.00 |
- 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 |