- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.75 / $722.75 / $6,781.00
| Facility | | $722.75 | $722.75 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,560.38 / $12,197.67 / $25,424.06
| Facility | | $3,560.38 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,756.06 / $2,491.59 / $5,993.86
| Facility | | $1,756.06 | $2,491.59 | $5,993.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,596.42 / $2,277.91 / $4,719.58
| Facility | | $1,596.42 | $2,277.91 | $4,719.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.40 / $1,262.01 / $4,671.00
| Facility | | $740.40 | $1,262.01 | $4,671.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,112.00 / $11,165.00
| Facility | | $3,940.00 | $7,112.00 | $11,165.00 |