- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.16 / $651.16 / $6,575.00
| Facility | | $651.16 | $651.16 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,768.64 / $5,518.80 / $11,503.06
| Facility | | $2,768.64 | $5,518.80 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.01 / $2,250.32 / $5,413.44
| Facility | | $1,586.01 | $2,250.32 | $5,413.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,441.83 / $2,057.33 / $4,262.55
| Facility | | $1,441.83 | $2,057.33 | $4,262.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.96 / $1,138.53 / $5,499.00
| Facility | | $676.96 | $1,138.53 | $5,499.00 |
- 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 |