- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.80 / $590.80 / $2,525.00
| Facility | | $590.80 | $590.80 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,507.17 / $13,558.82 / $26,448.94
| Facility | | $5,507.17 | $13,558.82 | $26,448.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.90 / $2,047.26 / $4,924.96
| Facility | | $1,442.90 | $2,047.26 | $4,924.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.72 / $1,871.69 / $3,877.93
| Facility | | $1,311.72 | $1,871.69 | $3,877.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.37 / $1,147.20 / $2,735.00
| Facility | | $644.37 | $1,147.20 | $2,735.00 |
- 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 |