- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.36 / $718.36 / $4,828.00
| Facility | | $718.36 | $718.36 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,377.36 / $12,197.67 / $25,424.06
| Facility | | $3,377.36 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,762.79 / $2,501.15 / $6,016.85
| Facility | | $1,762.79 | $2,501.15 | $6,016.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,602.54 / $2,286.65 / $4,737.68
| Facility | | $1,602.54 | $2,286.65 | $4,737.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $747.13 / $1,235.33 / $5,577.00
| Facility | | $747.13 | $1,235.33 | $5,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $11,890.00 / $23,633.78
| Facility | | $5,457.00 | $11,890.00 | $23,633.78 |