- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.71 / $932.71 / $2,525.00
| Facility | | $932.71 | $932.71 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,677.15 / $6,089.15 / $11,491.08
| Facility | | $3,677.15 | $6,089.15 | $11,491.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,267.05 / $3,216.61 / $7,738.00
| Facility | | $2,267.05 | $3,216.61 | $7,738.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,060.94 / $2,940.76 / $6,092.91
| Facility | | $2,060.94 | $2,940.76 | $6,092.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.80 / $1,576.28 / $3,500.00
| Facility | | $802.80 | $1,576.28 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |