- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.54 / $543.54 / $6,575.00
| Facility | | $543.54 | $543.54 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,736.32 / $6,273.82 / $12,790.57
| Facility | | $2,736.32 | $6,273.82 | $12,790.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.76 / $1,991.12 / $4,789.92
| Facility | | $1,275.76 | $1,991.12 | $4,789.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.55 / $1,817.03 / $3,771.59
| Facility | | $1,105.55 | $1,817.03 | $3,771.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.50 / $997.36 / $1,826.34
| Facility | | $576.50 | $997.36 | $1,826.34 |
- 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 |