- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.37 / $722.14 / $2,525.00
| Facility | | $589.37 | $722.14 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,377.02 / $4,416.67 / $8,615.51
| Facility | | $2,377.02 | $4,416.67 | $8,615.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,676.93 / $2,379.31 / $5,723.76
| Facility | | $1,676.93 | $2,379.31 | $5,723.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,363.92 / $2,175.26 / $4,506.89
| Facility | | $1,363.92 | $2,175.26 | $4,506.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.86 / $1,052.42 / $2,735.00
| Facility | | $648.86 | $1,052.42 | $2,735.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |