- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.14 / $770.14 / $2,525.00
| Facility | | $770.14 | $770.14 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,728.45 / $6,616.98 / $13,240.60
| Facility | | $3,728.45 | $6,616.98 | $13,240.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,796.92 / $2,804.53 / $6,746.68
| Facility | | $1,796.92 | $2,804.53 | $6,746.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.19 / $2,559.32 / $5,312.35
| Facility | | $1,557.19 | $2,559.32 | $5,312.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.11 / $1,534.04 / $2,608.77
| Facility | | $831.11 | $1,534.04 | $2,608.77 |
- 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 |