- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.87 / $560.87 / $6,575.00
| Facility | | $560.87 | $560.87 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,537.55 / $5,939.08 / $11,951.65
| Facility | | $2,537.55 | $5,939.08 | $11,951.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,364.61 / $1,936.18 / $4,657.74
| Facility | | $1,364.61 | $1,936.18 | $4,657.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.55 / $1,770.13 / $3,667.51
| Facility | | $1,240.55 | $1,770.13 | $3,667.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.25 / $960.57 / $3,293.00
| Facility | | $565.25 | $960.57 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |