- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.26 / $485.16 / $2,525.00
| Facility | | $275.26 | $485.16 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.37 / $1,692.60 / $2,845.25
| Facility | | $914.37 | $1,692.60 | $2,845.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,225.70 / $1,739.10 / $4,183.63
| Facility | | $1,225.70 | $1,739.10 | $4,183.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.62 / $1,589.95 / $3,294.20
| Facility | | $965.62 | $1,589.95 | $3,294.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.48 / $610.04 / $1,290.47
| Facility | | $325.48 | $610.04 | $1,290.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $2,872.00 / $4,241.00
| Facility | | $1,755.00 | $2,872.00 | $4,241.00 |