- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.89 / $707.89 / $6,575.00
| Facility | | $707.89 | $707.89 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,914.25 / $5,939.08 / $11,966.76
| Facility | | $2,914.25 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,706.39 / $2,421.12 / $5,824.33
| Facility | | $1,706.39 | $2,421.12 | $5,824.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,551.26 / $2,213.48 / $4,586.09
| Facility | | $1,551.26 | $2,213.48 | $4,586.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.00 / $1,196.33 / $2,523.00
| Facility | | $684.00 | $1,196.33 | $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 |