- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.75 / $703.75 / $3,638.00
| Facility | | $703.75 | $703.75 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,463.82 / $14,491.64 / $32,738.65
| Facility | | $4,463.82 | $14,491.64 | $32,738.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,785.60 / $2,532.19 / $6,091.56
| Facility | | $1,785.60 | $2,532.19 | $6,091.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,451.56 / $2,315.04 / $4,796.50
| Facility | | $1,451.56 | $2,315.04 | $4,796.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.67 / $1,477.82 / $7,770.00
| Facility | | $996.67 | $1,477.82 | $7,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |