- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.80 / $581.80 / $6,575.00
| Facility | | $581.80 | $581.80 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,635.33 / $5,939.08 / $11,966.76
| Facility | | $2,635.33 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.33 / $2,013.82 / $4,844.51
| Facility | | $1,419.33 | $2,013.82 | $4,844.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,290.30 / $1,841.11 / $3,814.58
| Facility | | $1,290.30 | $1,841.11 | $3,814.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.03 / $995.81 / $2,735.00
| Facility | | $584.03 | $995.81 | $2,735.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |