- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.40 / $580.40 / $3,119.00
| Facility | | $580.40 | $580.40 | $3,119.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,617.27 / $5,151.84 / $10,380.54
| Facility | | $2,617.27 | $5,151.84 | $10,380.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.88 / $2,117.73 / $5,094.49
| Facility | | $1,356.88 | $2,117.73 | $5,094.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.84 / $1,932.57 / $4,011.41
| Facility | | $1,175.84 | $1,932.57 | $4,011.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.33 / $1,213.04 / $2,889.89
| Facility | | $602.33 | $1,213.04 | $2,889.89 |
- 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 |