- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.67 / $750.67 / $2,525.00
| Facility | | $750.67 | $750.67 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,767.05 / $10,188.53 / $20,811.61
| Facility | | $3,767.05 | $10,188.53 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.19 / $2,747.20 / $6,608.76
| Facility | | $1,760.19 | $2,747.20 | $6,608.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.36 / $2,507.00 / $5,203.75
| Facility | | $1,525.36 | $2,507.00 | $5,203.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.67 / $1,355.29 / $2,450.50
| Facility | | $750.67 | $1,355.29 | $2,450.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $7,872.00 / $11,531.00
| Facility | | $2,960.00 | $7,872.00 | $11,531.00 |