- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.70 / $656.70 / $6,575.00
| Facility | | $656.70 | $656.70 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,095.37 / $12,197.67 / $25,424.06
| Facility | | $3,095.37 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,602.00 / $2,273.01 / $5,468.03
| Facility | | $1,602.00 | $2,273.01 | $5,468.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.37 / $2,078.08 / $4,305.54
| Facility | | $1,456.37 | $2,078.08 | $4,305.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.67 / $1,184.34 / $3,910.38
| Facility | | $670.67 | $1,184.34 | $3,910.38 |
- 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 |