- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.45 / $611.45 / $4,828.00
| Facility | | $611.45 | $611.45 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,836.20 / $12,197.67 / $25,424.06
| Facility | | $2,836.20 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,487.51 / $2,110.57 / $5,077.25
| Facility | | $1,487.51 | $2,110.57 | $5,077.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,352.29 / $1,929.56 / $3,997.84
| Facility | | $1,352.29 | $1,929.56 | $3,997.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.92 / $1,043.75 / $2,735.00
| Facility | | $630.92 | $1,043.75 | $2,735.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $3,756.00 / $8,193.00
| Facility | | $2,412.00 | $3,756.00 | $8,193.00 |