- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.88 / $567.88 / $2,525.00
| Facility | | $567.88 | $567.88 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,498.60 / $3,936.29 / $7,808.13
| Facility | | $2,498.60 | $3,936.29 | $7,808.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,399.96 / $1,986.35 / $4,778.42
| Facility | | $1,399.96 | $1,986.35 | $4,778.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.69 / $1,816.00 / $3,762.54
| Facility | | $1,272.69 | $1,816.00 | $3,762.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.86 / $1,036.71 / $3,410.70
| Facility | | $629.86 | $1,036.71 | $3,410.70 |
- 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 |