- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.36 / $835.84 / $2,525.00
| Facility | | $599.36 | $835.84 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,857.55 / $9,458.16 / $20,811.61
| Facility | | $2,857.55 | $9,458.16 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,146.09 / $3,043.42 / $7,321.36
| Facility | | $2,146.09 | $3,043.42 | $7,321.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,744.62 / $2,782.42 / $5,764.85
| Facility | | $1,744.62 | $2,782.42 | $5,764.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.14 / $1,309.95 / $4,746.00
| Facility | | $859.14 | $1,309.95 | $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 |