- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.51 / $859.51 / $4,828.00
| Facility | | $859.51 | $859.51 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,885.67 / $12,446.60 / $25,424.06
| Facility | | $3,885.67 | $12,446.60 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,087.73 / $2,962.20 / $7,125.97
| Facility | | $2,087.73 | $2,962.20 | $7,125.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,897.94 / $2,708.16 / $5,611.00
| Facility | | $1,897.94 | $2,708.16 | $5,611.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.34 / $1,454.36 / $5,577.00
| Facility | | $866.34 | $1,454.36 | $5,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |