- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.06 / $727.06 / $2,525.00
| Facility | | $727.06 | $727.06 | $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
- $1,760.27 / $2,497.56 / $6,008.23
| Facility | | $1,760.27 | $2,497.56 | $6,008.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,600.24 / $2,283.37 / $4,730.89
| Facility | | $1,600.24 | $2,283.37 | $4,730.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.10 / $1,228.73 / $2,523.00
| Facility | | $677.10 | $1,228.73 | $2,523.00 |
- 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 |