- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.61 / $512.61 / $2,525.00
| Facility | | $512.61 | $512.61 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.65 / $9,458.16 / $20,811.61
| Facility | | $1,077.65 | $9,458.16 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.23 / $1,871.68 / $4,502.58
| Facility | | $1,199.23 | $1,871.68 | $4,502.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.23 / $1,708.03 / $3,545.34
| Facility | | $1,039.23 | $1,708.03 | $3,545.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.90 / $1,035.78 / $2,202.50
| Facility | | $533.90 | $1,035.78 | $2,202.50 |
- 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 |