- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.10 / $887.52 / $2,525.00
| Facility | | $179.10 | $887.52 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.29 / $2,820.70 / $5,761.70
| Facility | | $1,335.29 | $2,820.70 | $5,761.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,877.06 / $3,148.53 / $7,574.22
| Facility | | $1,877.06 | $3,148.53 | $7,574.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,619.03 / $2,775.97 / $5,963.95
| Facility | | $1,619.03 | $2,775.97 | $5,963.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.14 / $831.85 / $2,514.88
| Facility | | $230.14 | $831.85 | $2,514.88 |
- 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 |