- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $943.14 / $943.14 / $7,397.00
| Facility | | $943.14 | $943.14 | $7,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,482.50 / $22,439.74 / $46,771.99
| Facility | | $4,482.50 | $22,439.74 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,288.09 / $3,246.47 / $7,809.83
| Facility | | $2,288.09 | $3,246.47 | $7,809.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.09 / $2,968.06 / $6,149.48
| Facility | | $2,080.09 | $2,968.06 | $6,149.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.49 / $1,613.21 / $6,961.21
| Facility | | $986.49 | $1,613.21 | $6,961.21 |
- 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 |