- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.08 / $590.08 / $3,465.00
| Facility | | $590.08 | $590.08 | $3,465.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,803.60 / $12,197.67 / $25,424.06
| Facility | | $2,803.60 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.64 / $2,034.12 / $4,893.35
| Facility | | $1,433.64 | $2,034.12 | $4,893.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.31 / $1,859.68 / $3,853.04
| Facility | | $1,303.31 | $1,859.68 | $3,853.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.34 / $1,011.89 / $3,293.00
| Facility | | $345.34 | $1,011.89 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |