- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.10 / $965.10 / $6,575.00
| Facility | | $965.10 | $965.10 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,671.14 / $10,188.53 / $21,650.55
| Facility | | $4,671.14 | $10,188.53 | $21,650.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,240.80 / $3,497.31 / $8,413.24
| Facility | | $2,240.80 | $3,497.31 | $8,413.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,941.85 / $3,191.52 / $6,624.60
| Facility | | $1,941.85 | $3,191.52 | $6,624.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.00 / $1,660.70 / $3,036.80
| Facility | | $949.00 | $1,660.70 | $3,036.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.00 / $4,746.00 / $8,812.00
| Facility | | $1,623.00 | $4,746.00 | $8,812.00 |