- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.02 / $534.02 / $4,828.00
| Facility | | $534.02 | $534.02 | $4,828.00 |
- 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
- $1,300.63 / $1,845.40 / $4,439.35
| Facility | | $1,300.63 | $1,845.40 | $4,439.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.39 / $1,687.14 / $3,495.56
| Facility | | $1,182.39 | $1,687.14 | $3,495.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.37 / $1,042.23 / $3,312.00
| Facility | | $581.37 | $1,042.23 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |