- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.61 / $724.61 / $6,575.00
| Facility | | $724.61 | $724.61 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,443.15 / $6,110.64 / $12,227.42
| Facility | | $3,443.15 | $6,110.64 | $12,227.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.44 / $2,649.26 / $6,373.15
| Facility | | $1,697.44 | $2,649.26 | $6,373.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.98 / $2,417.62 / $5,018.22
| Facility | | $1,470.98 | $2,417.62 | $5,018.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.10 / $1,322.64 / $2,313.09
| Facility | | $766.10 | $1,322.64 | $2,313.09 |
- 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 |