- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $2,238.72
| Facility | | $537.03 | $537.03 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $851.14 / $1,819.70
| Facility | | $380.19 | $851.14 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,949.84 / $4,677.35
| Facility | | $1,380.38 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,862.09 / $3,630.78
| Facility | | $1,513.56 | $1,862.09 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,000.00 / $1,737.80
| Facility | | $562.34 | $1,000.00 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,862.09 / $3,467.37
| Facility | | $380.19 | $1,862.09 | $3,467.37 |