- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.30 / $982.40 / $6,575.00
| Facility | | $682.30 | $982.40 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.28 / $4,306.26 / $7,808.13
| Facility | | $2,509.28 | $4,306.26 | $7,808.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,692.08 / $2,400.81 / $5,775.48
| Facility | | $1,692.08 | $2,400.81 | $5,775.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,538.25 / $2,194.92 / $4,547.63
| Facility | | $1,538.25 | $2,194.92 | $4,547.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.30 / $1,191.49 / $4,708.43
| Facility | | $682.30 | $1,191.49 | $4,708.43 |
- 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 |