- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.27 / $502.46 / $2,454.00
| Facility | | $377.27 | $502.46 | $2,454.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.74 / $2,764.29 / $5,761.70
| Facility | | $704.74 | $2,764.29 | $5,761.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,221.50 / $1,733.13 / $4,169.27
| Facility | | $1,221.50 | $1,733.13 | $4,169.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.45 / $1,584.49 / $3,282.89
| Facility | | $1,110.45 | $1,584.49 | $3,282.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.87 / $742.86 / $1,362.42
| Facility | | $418.87 | $742.86 | $1,362.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |