- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.60 / $409.60 / $6,575.00
| Facility | | $409.60 | $409.60 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,103.64 / $8,758.52 / $17,287.45
| Facility | | $5,103.64 | $8,758.52 | $17,287.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.06 / $1,279.24 / $3,077.38
| Facility | | $902.06 | $1,279.24 | $3,077.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.31 / $1,169.53 / $2,423.14
| Facility | | $733.31 | $1,169.53 | $2,423.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.75 / $794.81 / $9,404.00
| Facility | | $544.75 | $794.81 | $9,404.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |