- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.08 / $758.08 / $2,525.00
| Facility | | $758.08 | $758.08 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $6,513.04
| Facility | | $1,178.08 | $3,144.69 | $6,513.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.37 / $2,761.53 / $6,643.24
| Facility | | $1,769.37 | $2,761.53 | $6,643.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,533.32 / $2,520.08 / $5,230.89
| Facility | | $1,533.32 | $2,520.08 | $5,230.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.26 / $1,355.20 / $2,409.25
| Facility | | $808.26 | $1,355.20 | $2,409.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |