- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.40 / $760.43 / $2,168.00
| Facility | | $443.40 | $760.43 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,142.77 / $3,857.56 / $7,573.89
| Facility | | $2,142.77 | $3,857.56 | $7,573.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.03 / $2,627.76 / $6,321.43
| Facility | | $1,852.03 | $2,627.76 | $6,321.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.34 / $2,402.40 / $4,977.50
| Facility | | $1,506.34 | $2,402.40 | $4,977.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.46 / $924.70 / $2,018.43
| Facility | | $489.46 | $924.70 | $2,018.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |