- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.60 / $446.60 / $2,168.00
| Facility | | $446.60 | $446.60 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.51 / $5,631.43 / $11,503.06
| Facility | | $1,186.51 | $5,631.43 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.70 / $1,550.38 / $3,729.64
| Facility | | $1,092.70 | $1,550.38 | $3,729.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $993.36 / $1,417.42 / $2,936.73
| Facility | | $993.36 | $1,417.42 | $2,936.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.88 / $842.00 / $3,307.00
| Facility | | $449.88 | $842.00 | $3,307.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |