- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.41 / $867.41 / $6,575.00
| Facility | | $867.41 | $867.41 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,020.32 / $10,745.13 / $20,811.61
| Facility | | $4,020.32 | $10,745.13 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,101.21 / $2,981.31 / $7,171.94
| Facility | | $2,101.21 | $2,981.31 | $7,171.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,910.19 / $2,725.63 / $5,647.20
| Facility | | $1,910.19 | $2,725.63 | $5,647.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $893.33 / $1,467.85 / $4,793.64
| Facility | | $893.33 | $1,467.85 | $4,793.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |