- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.86 / $451.60 / $2,525.00
| Facility | | $274.86 | $451.60 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,139.83 / $4,575.71 / $10,098.06
| Facility | | $1,139.83 | $4,575.71 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.63 / $1,600.54 / $3,850.32
| Facility | | $1,128.63 | $1,600.54 | $3,850.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.50 / $1,463.28 / $3,031.75
| Facility | | $917.50 | $1,463.28 | $3,031.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.45 / $559.64 / $1,382.16
| Facility | | $317.45 | $559.64 | $1,382.16 |
- 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 |