- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.35 / $437.35 / $2,525.00
| Facility | | $437.35 | $437.35 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,920.39 / $5,631.43 / $11,503.06
| Facility | | $1,920.39 | $5,631.43 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.59 / $1,513.35 / $3,640.57
| Facility | | $1,066.59 | $1,513.35 | $3,640.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.64 / $1,383.56 / $2,866.59
| Facility | | $969.64 | $1,383.56 | $2,866.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.55 / $764.86 / $3,854.93
| Facility | | $433.55 | $764.86 | $3,854.93 |
- 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 |