- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.64 / $792.64 / $6,575.00
| Facility | | $792.64 | $792.64 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,637.21 / $12,197.67 / $25,424.06
| Facility | | $3,637.21 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,927.79 / $2,735.26 / $6,580.03
| Facility | | $1,927.79 | $2,735.26 | $6,580.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,752.54 / $2,500.67 / $5,181.13
| Facility | | $1,752.54 | $2,500.67 | $5,181.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.81 / $1,355.49 / $5,577.00
| Facility | | $859.81 | $1,355.49 | $5,577.00 |
- 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 |