- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.76 / $845.76 / $6,575.00
| Facility | | $845.76 | $845.76 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,783.51 / $6,707.59 / $13,675.19
| Facility | | $3,783.51 | $6,707.59 | $13,675.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.56 / $3,039.84 / $7,312.74
| Facility | | $2,143.56 | $3,039.84 | $7,312.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,742.56 / $2,779.14 / $5,758.06
| Facility | | $1,742.56 | $2,779.14 | $5,758.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.85 / $1,670.17 / $5,499.00
| Facility | | $1,199.85 | $1,670.17 | $5,499.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |