- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.07 / $510.07 / $2,168.00
| Facility | | $510.07 | $510.07 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,172.80 / $3,857.56 / $7,573.89
| Facility | | $2,172.80 | $3,857.56 | $7,573.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.48 / $1,801.21 / $4,333.05
| Facility | | $1,269.48 | $1,801.21 | $4,333.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.07 / $1,646.74 / $3,411.85
| Facility | | $1,154.07 | $1,646.74 | $3,411.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.63 / $889.31 / $3,312.00
| Facility | | $455.63 | $889.31 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $5,058.83 / $8,812.00
| Facility | | $2,412.00 | $5,058.83 | $8,812.00 |