- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.05 / $785.68 / $2,525.00
| Facility | | $627.05 | $785.68 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,741.91 / $5,907.47 / $11,903.07
| Facility | | $2,741.91 | $5,907.47 | $11,903.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,910.95 / $2,711.37 / $6,522.56
| Facility | | $1,910.95 | $2,711.37 | $6,522.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.23 / $2,478.84 / $5,135.88
| Facility | | $1,737.23 | $2,478.84 | $5,135.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.57 / $1,220.46 / $2,144.75
| Facility | | $739.57 | $1,220.46 | $2,144.75 |
- 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 |