- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.73 / $533.73 / $2,525.00
| Facility | | $533.73 | $533.73 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,489.64 / $4,992.57 / $10,380.54
| Facility | | $2,489.64 | $4,992.57 | $10,380.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,237.49 / $1,931.40 / $4,646.25
| Facility | | $1,237.49 | $1,931.40 | $4,646.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,072.39 / $1,762.53 / $3,658.46
| Facility | | $1,072.39 | $1,762.53 | $3,658.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.35 / $958.10 / $1,751.78
| Facility | | $452.35 | $958.10 | $1,751.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |