- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.07 / $686.07 / $2,168.00
| Facility | | $686.07 | $686.07 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.67 / $7,465.39 / $14,249.16
| Facility | | $4,206.67 | $7,465.39 | $14,249.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.14 / $2,362.59 / $5,683.54
| Facility | | $1,665.14 | $2,362.59 | $5,683.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.76 / $2,159.98 / $4,475.22
| Facility | | $1,513.76 | $2,159.98 | $4,475.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.04 / $1,159.46 / $3,312.00
| Facility | | $641.04 | $1,159.46 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |