- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.06 / $686.06 / $2,525.00
| Facility | | $686.06 | $686.06 | $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
- $1,653.35 / $2,345.87 / $5,643.31
| Facility | | $1,653.35 | $2,345.87 | $5,643.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,503.05 / $2,144.69 / $4,443.55
| Facility | | $1,503.05 | $2,144.69 | $4,443.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.50 / $1,159.44 / $2,451.08
| Facility | | $695.50 | $1,159.44 | $2,451.08 |
- 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 |