- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.18 / $816.18 / $5,010.00
| Facility | | $816.18 | $816.18 | $5,010.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,701.86 / $6,246.29 / $12,263.87
| Facility | | $3,701.86 | $6,246.29 | $12,263.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,162.92 / $3,067.31 / $7,378.83
| Facility | | $2,162.92 | $3,067.31 | $7,378.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.31 / $2,804.26 / $5,810.10
| Facility | | $1,758.31 | $2,804.26 | $5,810.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.75 / $1,659.64 / $3,378.00
| Facility | | $1,175.75 | $1,659.64 | $3,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |