- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.42 / $639.44 / $2,525.00
| Facility | | $421.42 | $639.44 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.88 / $4,844.72 / $10,098.06
| Facility | | $646.88 | $4,844.72 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,556.54 / $2,208.51 / $5,312.87
| Facility | | $1,556.54 | $2,208.51 | $5,312.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,415.04 / $2,019.11 / $4,183.35
| Facility | | $1,415.04 | $2,019.11 | $4,183.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $866.02 / $1,722.84
| Facility | | $425.00 | $866.02 | $1,722.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |