- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.80 / $956.80 / $3,638.00
| Facility | | $956.80 | $956.80 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.61 / $5,197.49 / $9,424.12
| Facility | | $3,028.61 | $5,197.49 | $9,424.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,227.48 / $3,160.48 / $7,602.95
| Facility | | $2,227.48 | $3,160.48 | $7,602.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,811.72 / $2,889.43 / $5,986.58
| Facility | | $1,811.72 | $2,889.43 | $5,986.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $982.93 / $1,665.55 / $5,908.43
| Facility | | $982.93 | $1,665.55 | $5,908.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |