- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.63 / $574.63 / $6,575.00
| Facility | | $574.63 | $574.63 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,935.09 / $6,273.82 / $12,790.57
| Facility | | $2,935.09 | $6,273.82 | $12,790.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.57 / $2,093.84 / $5,037.03
| Facility | | $1,341.57 | $2,093.84 | $5,037.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.58 / $1,910.77 / $3,966.16
| Facility | | $1,162.58 | $1,910.77 | $3,966.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.65 / $1,059.00 / $1,936.70
| Facility | | $619.65 | $1,059.00 | $1,936.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $4,506.00 / $9,404.00
| Facility | | $2,100.00 | $4,506.00 | $9,404.00 |