- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.83 / $688.83 / $2,168.00
| Facility | | $688.83 | $688.83 | $2,168.00 |
- 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
- $1,646.62 / $2,336.31 / $5,620.32
| Facility | | $1,646.62 | $2,336.31 | $5,620.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,496.93 / $2,135.94 / $4,425.45
| Facility | | $1,496.93 | $2,135.94 | $4,425.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.83 / $1,164.11 / $2,443.67
| Facility | | $688.83 | $1,164.11 | $2,443.67 |
- 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 |