- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.51 / $974.51 / $5,716.00
| Facility | | $974.51 | $974.51 | $5,716.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,837.58 / $7,208.81 / $15,031.63
| Facility | | $3,837.58 | $7,208.81 | $15,031.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,256.94 / $3,202.28 / $7,703.52
| Facility | | $2,256.94 | $3,202.28 | $7,703.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,835.68 / $2,927.65 / $6,065.76
| Facility | | $1,835.68 | $2,927.65 | $6,065.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.52 / $1,646.92 / $6,740.00
| Facility | | $933.52 | $1,646.92 | $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 |