- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.30 / $628.30 / $4,828.00
| Facility | | $628.30 | $628.30 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,919.33 / $12,197.67 / $25,424.06
| Facility | | $2,919.33 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,531.29 / $2,172.67 / $5,226.67
| Facility | | $1,531.29 | $2,172.67 | $5,226.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.08 / $1,986.35 / $4,115.49
| Facility | | $1,392.08 | $1,986.35 | $4,115.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.96 / $1,103.45 / $5,913.00
| Facility | | $634.96 | $1,103.45 | $5,913.00 |
- 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 |