- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.85 / $636.85 / $2,168.00
| Facility | | $636.85 | $636.85 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $3,695.10 / $6,499.58
| Facility | | $2,088.76 | $3,695.10 | $6,499.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,555.70 / $2,207.32 / $5,310.00
| Facility | | $1,555.70 | $2,207.32 | $5,310.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,414.27 / $2,018.02 / $4,181.10
| Facility | | $1,414.27 | $2,018.02 | $4,181.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.02 / $1,093.63 / $2,403.52
| Facility | | $622.02 | $1,093.63 | $2,403.52 |
- 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 |