- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.77 / $505.77 / $2,525.00
| Facility | | $505.77 | $505.77 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,392.84 / $11,716.49 / $25,424.06
| Facility | | $2,392.84 | $11,716.49 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.76 / $1,746.26 / $4,200.87
| Facility | | $1,230.76 | $1,746.26 | $4,200.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.86 / $1,596.50 / $3,307.78
| Facility | | $1,118.86 | $1,596.50 | $3,307.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.62 / $866.47 / $3,293.00
| Facility | | $511.62 | $866.47 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |