- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.78 / $552.78 / $3,638.00
| Facility | | $552.78 | $552.78 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,598.21 / $12,034.70 / $25,424.06
| Facility | | $2,598.21 | $12,034.70 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.93 / $1,911.10 / $4,597.39
| Facility | | $1,346.93 | $1,911.10 | $4,597.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.48 / $1,747.20 / $3,620.00
| Facility | | $1,224.48 | $1,747.20 | $3,620.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.62 / $966.22 / $3,293.00
| Facility | | $600.62 | $966.22 | $3,293.00 |
- 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 |