- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.31 / $653.51 / $2,525.00
| Facility | | $508.31 | $653.51 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,197.71 / $5,601.46 / $11,441.84
| Facility | | $2,197.71 | $5,601.46 | $11,441.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.34 / $2,163.12 / $5,203.68
| Facility | | $1,525.34 | $2,163.12 | $5,203.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,239.99 / $1,977.61 / $4,097.39
| Facility | | $1,239.99 | $1,977.61 | $4,097.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.71 / $991.83 / $4,746.00
| Facility | | $662.71 | $991.83 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |