- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.30 / $470.73 / $2,525.00
| Facility | | $306.30 | $470.73 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,413.00 / $3,109.26 / $6,741.99
| Facility | | $1,413.00 | $3,109.26 | $6,741.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.96 / $1,688.93 / $4,062.95
| Facility | | $1,190.96 | $1,688.93 | $4,062.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $968.17 / $1,544.09 / $3,199.18
| Facility | | $968.17 | $1,544.09 | $3,199.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.36 / $643.86 / $1,503.00
| Facility | | $359.36 | $643.86 | $1,503.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |