- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.31 / $705.31 / $2,525.00
| Facility | | $705.31 | $705.31 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.11 / $2,764.29 / $5,761.70
| Facility | | $791.11 | $2,764.29 | $5,761.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,707.23 / $2,422.31 / $5,827.20
| Facility | | $1,707.23 | $2,422.31 | $5,827.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,552.03 / $2,214.58 / $4,588.35
| Facility | | $1,552.03 | $2,214.58 | $4,588.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.60 / $1,191.97 / $2,097.00
| Facility | | $696.60 | $1,191.97 | $2,097.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.00 / $2,872.00 / $4,241.00
| Facility | | $1,187.00 | $2,872.00 | $4,241.00 |