- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.85 / $582.92 / $4,557.00
| Facility | | $411.85 | $582.92 | $4,557.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,849.86 / $5,631.43 / $11,503.06
| Facility | | $1,849.86 | $5,631.43 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,427.74 / $2,025.76 / $4,873.24
| Facility | | $1,427.74 | $2,025.76 | $4,873.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,297.95 / $1,852.03 / $3,837.20
| Facility | | $1,297.95 | $1,852.03 | $3,837.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.35 / $835.17 / $1,562.06
| Facility | | $409.35 | $835.17 | $1,562.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |