- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.75 / $402.75 / $2,525.00
| Facility | | $402.75 | $402.75 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.29 / $5,601.46 / $11,441.84
| Facility | | $1,973.29 | $5,601.46 | $11,441.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.34 / $1,509.77 / $3,631.95
| Facility | | $967.34 | $1,509.77 | $3,631.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $838.28 / $1,377.76 / $2,859.80
| Facility | | $838.28 | $1,377.76 | $2,859.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.11 / $740.92 / $1,332.06
| Facility | | $410.11 | $740.92 | $1,332.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.00 / $4,746.00 / $8,812.00
| Facility | | $1,623.00 | $4,746.00 | $8,812.00 |