- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.66 / $628.54 / $2,168.00
| Facility | | $582.66 | $628.54 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.58 / $5,631.43 / $11,503.06
| Facility | | $1,270.58 | $5,631.43 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,536.34 / $2,179.84 / $5,243.91
| Facility | | $1,536.34 | $2,179.84 | $5,243.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,396.67 / $1,992.90 / $4,129.06
| Facility | | $1,396.67 | $1,992.90 | $4,129.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.61 / $1,022.88 / $1,725.63
| Facility | | $590.61 | $1,022.88 | $1,725.63 |
- 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 |