- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.44 / $574.44 / $4,828.00
| Facility | | $574.44 | $574.44 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,163.84 / $9,458.16 / $20,811.61
| Facility | | $1,163.84 | $9,458.16 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.21 / $2,085.48 / $5,016.91
| Facility | | $1,336.21 | $2,085.48 | $5,016.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.95 / $1,903.14 / $3,950.33
| Facility | | $1,157.95 | $1,903.14 | $3,950.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.13 / $1,008.05 / $1,803.58
| Facility | | $555.13 | $1,008.05 | $1,803.58 |
- 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 |