- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.85 / $506.85 / $6,575.00
| Facility | | $506.85 | $506.85 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,102.68 / $3,825.02 / $8,281.67
| Facility | | $1,102.68 | $3,825.02 | $8,281.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.98 / $1,684.15 / $4,051.46
| Facility | | $1,186.98 | $1,684.15 | $4,051.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.43 / $1,539.72 / $3,190.13
| Facility | | $965.43 | $1,539.72 | $3,190.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.97 / $896.38 / $5,499.18
| Facility | | $506.97 | $896.38 | $5,499.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,312.00 / $5,959.58 / $8,812.00
| Facility | | $3,312.00 | $5,959.58 | $8,812.00 |