- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $946.42 / $946.42 / $4,828.00
| Facility | | $946.42 | $946.42 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,441.91 / $12,802.02 / $25,424.06
| Facility | | $4,441.91 | $12,802.02 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.46 / $3,251.25 / $7,821.33
| Facility | | $2,291.46 | $3,251.25 | $7,821.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,083.15 / $2,972.42 / $6,158.53
| Facility | | $2,083.15 | $2,972.42 | $6,158.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.41 / $1,782.56 / $9,370.00
| Facility | | $980.41 | $1,782.56 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $5,457.00 / $12,774.00
| Facility | | $2,740.00 | $5,457.00 | $12,774.00 |