- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.86 / $645.86 / $2,525.00
| Facility | | $645.86 | $645.86 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,004.02 / $5,939.08 / $11,966.76
| Facility | | $3,004.02 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,570.85 / $2,228.82 / $5,361.72
| Facility | | $1,570.85 | $2,228.82 | $5,361.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.05 / $2,037.67 / $4,221.83
| Facility | | $1,428.05 | $2,037.67 | $4,221.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.17 / $1,103.22 / $3,991.00
| Facility | | $668.17 | $1,103.22 | $3,991.00 |
- 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 |