- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.16 / $748.16 / $7,397.00
| Facility | | $748.16 | $748.16 | $7,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,422.41 / $10,188.53 / $20,811.61
| Facility | | $3,422.41 | $10,188.53 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,806.57 / $2,563.26 / $6,166.26
| Facility | | $1,806.57 | $2,563.26 | $6,166.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.33 / $2,343.42 / $4,855.33
| Facility | | $1,642.33 | $2,343.42 | $4,855.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.01 / $1,290.19 / $4,848.83
| Facility | | $802.01 | $1,290.19 | $4,848.83 |
- 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 |