- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.02 / $864.02 / $6,781.00
| Facility | | $864.02 | $864.02 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,079.89 / $22,439.74 / $46,771.99
| Facility | | $4,079.89 | $22,439.74 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,092.79 / $2,969.37 / $7,143.21
| Facility | | $2,092.79 | $2,969.37 | $7,143.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.54 / $2,714.71 / $5,624.58
| Facility | | $1,902.54 | $2,714.71 | $5,624.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.53 / $1,507.23 / $4,273.00
| Facility | | $895.53 | $1,507.23 | $4,273.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |