- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.07 / $598.79 / $2,525.00
| Facility | | $438.07 | $598.79 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.10 / $3,744.92 / $8,304.51
| Facility | | $963.10 | $3,744.92 | $8,304.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.70 / $1,973.21 / $4,746.82
| Facility | | $1,390.70 | $1,973.21 | $4,746.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.11 / $1,803.98 / $3,737.65
| Facility | | $1,131.11 | $1,803.98 | $3,737.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.00 / $788.60 / $1,679.98
| Facility | | $459.00 | $788.60 | $1,679.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |