- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.83 / $723.87 / $2,168.00
| Facility | | $526.83 | $723.87 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,167.10 / $11,688.59
| Facility | | $2,088.76 | $5,167.10 | $11,688.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,744.27 / $2,474.87 / $5,953.63
| Facility | | $1,744.27 | $2,474.87 | $5,953.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,585.70 / $2,262.62 / $4,687.89
| Facility | | $1,585.70 | $2,262.62 | $4,687.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.40 / $1,050.17 / $1,908.27
| Facility | | $536.40 | $1,050.17 | $1,908.27 |
- 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 |