- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.52 / $710.52 / $6,575.00
| Facility | | $710.52 | $710.52 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.52 / $6,932.26 / $14,449.17
| Facility | | $1,548.52 | $6,932.26 | $14,449.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,654.20 / $2,347.06 / $5,646.18
| Facility | | $1,654.20 | $2,347.06 | $5,646.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.44 / $2,145.78 / $4,445.81
| Facility | | $1,345.44 | $2,145.78 | $4,445.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.01 / $1,236.83 / $6,740.00
| Facility | | $728.01 | $1,236.83 | $6,740.00 |
- 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 |