- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $6,760.83
| Facility | | $707.95 | $707.95 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $10,000.00 / $23,442.29
| Facility | | $1,862.09 | $10,000.00 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,454.71 / $5,888.44
| Facility | | $1,737.80 | $2,454.71 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $4,677.35
| Facility | | $1,905.46 | $2,344.23 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,230.27 / $6,760.83
| Facility | | $741.31 | $1,230.27 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,248.07 / $13,489.63
| Facility | | $1,584.89 | $5,248.07 | $13,489.63 |