- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.11 / $557.11 / $2,525.00
| Facility | | $557.11 | $557.11 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,518.31 / $5,939.08 / $11,861.05
| Facility | | $2,518.31 | $5,939.08 | $11,861.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,357.87 / $1,926.62 / $4,634.75
| Facility | | $1,357.87 | $1,926.62 | $4,634.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,234.43 / $1,761.40 / $3,649.41
| Facility | | $1,234.43 | $1,761.40 | $3,649.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.88 / $955.53 / $2,735.00
| Facility | | $491.88 | $955.53 | $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 |