- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.64 / $573.64 / $2,525.00
| Facility | | $573.64 | $573.64 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,471.08 / $11,716.49 / $25,424.06
| Facility | | $2,471.08 | $11,716.49 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,463.10 / $2,075.92 / $4,993.93
| Facility | | $1,463.10 | $2,075.92 | $4,993.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.09 / $1,897.90 / $3,932.23
| Facility | | $1,330.09 | $1,897.90 | $3,932.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.64 / $1,019.95 / $2,735.00
| Facility | | $573.64 | $1,019.95 | $2,735.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $7,770.00 / $23,633.78
| Facility | | $2,412.00 | $7,770.00 | $23,633.78 |