- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.26 / $608.26 / $4,828.00
| Facility | | $608.26 | $608.26 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,815.01 / $12,197.67 / $25,424.06
| Facility | | $2,815.01 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,489.20 / $2,112.96 / $5,083.00
| Facility | | $1,489.20 | $2,112.96 | $5,083.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,353.82 / $1,931.75 / $4,002.36
| Facility | | $1,353.82 | $1,931.75 | $4,002.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.37 / $1,045.69 / $3,991.00
| Facility | | $614.37 | $1,045.69 | $3,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |