- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.26 / $643.26 / $2,525.00
| Facility | | $643.26 | $643.26 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,882.47 / $5,321.49 / $10,542.35
| Facility | | $2,882.47 | $5,321.49 | $10,542.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,505.35 / $2,349.44 / $5,651.93
| Facility | | $1,505.35 | $2,349.44 | $5,651.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.51 / $2,144.03 / $4,450.34
| Facility | | $1,304.51 | $2,144.03 | $4,450.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.26 / $1,162.22 / $2,102.85
| Facility | | $643.26 | $1,162.22 | $2,102.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $5,499.00 / $9,810.00
| Facility | | $2,100.00 | $5,499.00 | $9,810.00 |