- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.83 / $563.83 / $6,575.00
| Facility | | $563.83 | $563.83 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,608.08 / $5,939.08 / $11,966.76
| Facility | | $2,608.08 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,372.18 / $1,946.93 / $4,683.60
| Facility | | $1,372.18 | $1,946.93 | $4,683.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.44 / $1,779.96 / $3,687.88
| Facility | | $1,247.44 | $1,779.96 | $3,687.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.83 / $968.54 / $2,296.00
| Facility | | $563.83 | $968.54 | $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 |