- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.05 / $906.05 / $3,638.00
| Facility | | $906.05 | $906.05 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,888.29 / $4,018.18 / $8,281.67
| Facility | | $1,888.29 | $4,018.18 | $8,281.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,111.31 / $2,995.64 / $7,206.42
| Facility | | $2,111.31 | $2,995.64 | $7,206.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,717.23 / $2,738.74 / $5,674.35
| Facility | | $1,717.23 | $2,738.74 | $5,674.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.25 / $1,531.22 / $5,499.18
| Facility | | $857.25 | $1,531.22 | $5,499.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,289.00 / $4,956.60 / $8,882.00
| Facility | | $4,289.00 | $4,956.60 | $8,882.00 |