- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.49 / $727.49 / $6,575.00
| Facility | | $727.49 | $727.49 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,997.18 / $4,764.06 / $9,221.52
| Facility | | $2,997.18 | $4,764.06 | $9,221.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.13 / $2,407.98 / $5,792.72
| Facility | | $1,697.13 | $2,407.98 | $5,792.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.36 / $2,201.46 / $4,561.20
| Facility | | $1,380.36 | $2,201.46 | $4,561.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.31 / $1,286.58 / $5,625.11
| Facility | | $759.31 | $1,286.58 | $5,625.11 |
- 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 |