- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.14 / $929.14 / $6,575.00
| Facility | | $929.14 | $929.14 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,449.37 / $7,999.62
| Facility | | $2,088.76 | $4,449.37 | $7,999.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,251.90 / $3,195.11 / $7,686.28
| Facility | | $2,251.90 | $3,195.11 | $7,686.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.18 / $2,921.10 / $6,052.19
| Facility | | $2,047.18 | $2,921.10 | $6,052.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.37 / $1,571.51 / $2,733.30
| Facility | | $960.37 | $1,571.51 | $2,733.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |