- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.34 / $659.34 / $4,828.00
| Facility | | $659.34 | $659.34 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,070.92 / $12,197.67 / $25,424.06
| Facility | | $3,070.92 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,605.37 / $2,277.79 / $5,479.53
| Facility | | $1,605.37 | $2,277.79 | $5,479.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,459.43 / $2,082.44 / $4,314.59
| Facility | | $1,459.43 | $2,082.44 | $4,314.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.60 / $1,246.26 / $4,273.00
| Facility | | $716.60 | $1,246.26 | $4,273.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |