- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.91 / $522.91 / $2,525.00
| Facility | | $522.91 | $522.91 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,316.34 / $5,939.08 / $11,503.06
| Facility | | $2,316.34 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.36 / $1,809.57 / $4,353.16
| Facility | | $1,275.36 | $1,809.57 | $4,353.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.43 / $1,654.38 / $3,427.69
| Facility | | $1,159.43 | $1,654.38 | $3,427.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.21 / $892.49 / $2,735.00
| Facility | | $514.21 | $892.49 | $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 |