- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.24 / $504.24 / $6,575.00
| Facility | | $504.24 | $504.24 | $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
- $1,110.95 / $1,575.46 / $3,789.98
| Facility | | $1,110.95 | $1,575.46 | $3,789.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.12 / $1,440.35 / $2,984.24
| Facility | | $903.12 | $1,440.35 | $2,984.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.72 / $980.86 / $9,404.00
| Facility | | $699.72 | $980.86 | $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 |