- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.56 / $555.24 / $2,525.00
| Facility | | $496.56 | $555.24 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.41 / $3,046.07 / $5,941.90
| Facility | | $1,269.41 | $3,046.07 | $5,941.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,357.03 / $1,925.43 / $4,631.88
| Facility | | $1,357.03 | $1,925.43 | $4,631.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.66 / $1,760.30 / $3,647.15
| Facility | | $1,233.66 | $1,760.30 | $3,647.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.24 / $897.82 / $1,531.58
| Facility | | $555.24 | $897.82 | $1,531.58 |
- 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 |