- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.86 / $975.04 / $4,828.00
| Facility | | $536.86 | $975.04 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,645.43 / $5,396.85 / $11,503.06
| Facility | | $2,645.43 | $5,396.85 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.57 / $1,860.93 / $4,476.72
| Facility | | $1,311.57 | $1,860.93 | $4,476.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,192.33 / $1,701.34 / $3,524.98
| Facility | | $1,192.33 | $1,701.34 | $3,524.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.54 / $1,013.70 / $5,499.00
| Facility | | $557.54 | $1,013.70 | $5,499.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $7,823.25 / $10,734.22
| Facility | | $3,121.00 | $7,823.25 | $10,734.22 |