- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.08 / $565.08 / $3,638.00
| Facility | | $565.08 | $565.08 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,585.64 / $6,631.62 / $13,546.10
| Facility | | $2,585.64 | $6,631.62 | $13,546.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.31 / $1,913.48 / $4,603.14
| Facility | | $1,349.31 | $1,913.48 | $4,603.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.89 / $1,749.38 / $3,624.53
| Facility | | $1,096.89 | $1,749.38 | $3,624.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.38 / $1,086.88 / $7,770.00
| Facility | | $677.38 | $1,086.88 | $7,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |