- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.02 / $594.02 / $2,525.00
| Facility | | $594.02 | $594.02 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.67 / $7,465.39 / $14,249.16
| Facility | | $4,206.67 | $7,465.39 | $14,249.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.95 / $2,054.42 / $4,942.21
| Facility | | $1,447.95 | $2,054.42 | $4,942.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.32 / $1,878.24 / $3,891.50
| Facility | | $1,316.32 | $1,878.24 | $3,891.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.85 / $1,018.71 / $3,360.90
| Facility | | $601.85 | $1,018.71 | $3,360.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $7,770.00 / $10,734.22
| Facility | | $2,412.00 | $7,770.00 | $10,734.22 |