- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $660.69 / $660.69
| Facility | | $501.19 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,079.46 / $14,791.08
| Facility | | $2,951.21 | $7,079.46 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,454.71 / $5,754.40
| Facility | | $1,698.24 | $2,454.71 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,344.23 / $4,570.88
| Facility | | $1,862.09 | $2,344.23 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,000.00 / $1,995.26
| Facility | | $478.63 | $1,000.00 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,888.44 / $9,120.11
| Facility | | $2,754.23 | $5,888.44 | $9,120.11 |