- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.86 / $799.32 / $2,525.00
| Facility | | $673.86 | $799.32 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.81 / $3,057.02 / $6,480.74
| Facility | | $1,296.81 | $3,057.02 | $6,480.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,013.01 / $2,854.70 / $6,867.37
| Facility | | $2,013.01 | $2,854.70 | $6,867.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.43 / $2,609.88 / $5,407.38
| Facility | | $1,636.43 | $2,609.88 | $5,407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $782.50 / $1,247.50 / $2,446.39
| Facility | | $782.50 | $1,247.50 | $2,446.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,296.00 / $3,500.00 / $6,361.00
| Facility | | $2,296.00 | $3,500.00 | $6,361.00 |