- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.15 / $541.91 / $2,525.00
| Facility | | $386.15 | $541.91 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,854.67 / $5,489.43 / $11,441.84
| Facility | | $1,854.67 | $5,489.43 | $11,441.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.89 / $1,969.62 / $4,738.20
| Facility | | $1,388.89 | $1,969.62 | $4,738.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.07 / $1,800.71 / $3,730.86
| Facility | | $1,129.07 | $1,800.71 | $3,730.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.70 / $767.84 / $1,591.90
| Facility | | $460.70 | $767.84 | $1,591.90 |
- 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 |