- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.10 / $711.10 / $2,168.00
| Facility | | $711.10 | $711.10 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.96 / $778.05 / $5,541.84
| Facility | | $370.96 | $778.05 | $5,541.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,724.91 / $2,447.40 / $5,887.55
| Facility | | $1,724.91 | $2,447.40 | $5,887.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,568.10 / $2,237.51 / $4,635.85
| Facility | | $1,568.10 | $2,237.51 | $4,635.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.02 / $1,207.86 / $2,091.88
| Facility | | $756.02 | $1,207.86 | $2,091.88 |
- 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 |