- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.32 / $796.32 / $4,828.00
| Facility | | $796.32 | $796.32 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.41 / $3,046.07 / $5,941.90
| Facility | | $1,269.41 | $3,046.07 | $5,941.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,931.16 / $2,740.03 / $6,591.52
| Facility | | $1,931.16 | $2,740.03 | $6,591.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.60 / $2,505.05 / $5,190.18
| Facility | | $1,755.60 | $2,505.05 | $5,190.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.32 / $1,349.50 / $2,249.16
| Facility | | $796.32 | $1,349.50 | $2,249.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.00 / $1,590.00 / $3,584.00
| Facility | | $563.00 | $1,590.00 | $3,584.00 |