- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.70 / $977.70 / $9,658.00
| Facility | | $977.70 | $977.70 | $9,658.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,607.02 / $13,126.55 / $25,424.06
| Facility | | $4,607.02 | $13,126.55 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.69 / $3,355.17 / $8,071.31
| Facility | | $2,364.69 | $3,355.17 | $8,071.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,149.73 / $3,067.43 / $6,355.36
| Facility | | $2,149.73 | $3,067.43 | $6,355.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.24 / $1,804.59 / $6,241.80
| Facility | | $1,050.24 | $1,804.59 | $6,241.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |