- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,833.17 / $2,490.51 / $3,790.00
| Facility | | $1,833.17 | $2,490.51 | $3,790.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,799.07 / $3,156.33 / $4,474.03
| Facility | | $1,799.07 | $3,156.33 | $4,474.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,464.73 / $2,332.56 / $3,861.40
| Facility | | $1,464.73 | $2,332.56 | $3,861.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,540.26 / $2,131.67 / $4,395.60
| Facility | | $1,540.26 | $2,131.67 | $4,395.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.00 / $25.17 / $100.00
| Facility | | $17.00 | $25.17 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.00 / $2,142.46 / $3,732.46
| Facility | | $808.00 | $2,142.46 | $3,732.46 |