- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.87 / $3,116.88 / $4,069.53
| Facility | | $1,324.87 | $3,116.88 | $4,069.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $2,213.58 / $6,262.76
| Facility | | $750.00 | $2,213.58 | $6,262.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,693.40 / $1,894.30 / $4,455.93
| Facility | | $1,693.40 | $1,894.30 | $4,455.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,135.46 / $4,135.46 / $4,135.46
| Facility | | $4,135.46 | $4,135.46 | $4,135.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,537.46 / $2,933.66 / $4,530.27
| Facility | | $2,537.46 | $2,933.66 | $4,530.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $2,213.58 / $6,262.76
| Facility | | $750.00 | $2,213.58 | $6,262.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $2,023.97 / $3,775.00
| Facility | | $750.00 | $2,023.97 | $3,775.00 |